As the impact of hepatic fat accumulation per se on CKD is still a matter of debate, we aim to investigate whether NAFLD-associated gene variants in PNPLA3, TM6SF2, MBOAT7 and GCKR genes or the features of metabolic syndrome affect the decline of renal function in a large population of adult NAFLD patients. This evidence concerns the gene PNPLA3 and metabolic syndrome.