Colon to Rectum
Am J Gastroenterol. 2024;119(1):138–46
Absolute and relative risks of kidney and urological complications in patients with inflammatory bowel disease
Introduction: The burden of kidney and urological complications in patients with inflammatory bowel disease (IBD) remains poorly characterized.
Methods: The authors analyzed association between developing IBD (as a time-varying exposure) and relative risks of receiving diagnoses of chronic kidney disease (CKD), acute kidney injury (AKI), or kidney stones, and experiencing a clinically-relevant decline in estimated glomerular filtration rate (eGFR) (CKD progression; composite of kidney failure or an eGFR decline ≥ 30%) in 1,682,795 individuals seeking healthcare in Stockholm, Sweden, during 2006–2018. They quantified 5- and 10-year absolute risks of these complications in a parallel matched cohort of IBD cases and random controls matched (1:5) on sex, age, and eGFR.
Results: During median 9 years, 10,117 participants developed IBD. Incident IBD was associated with higher risks of kidney-related complications compared with non-IBD periods: hazard ratio (HR) was 1.24 (95% confidence interval: 1.10–1.40) for receiving a CKD diagnosis and 1.11 (95% CI: 1.00–1.24) for CKD progression. For absolute risks, 11.8% IBD cases had a CKD event within 10-year. Of these, 6.4% received a CKD diagnosis, and 7.9% reached CKD progression. The risks of AKI (HR = 1.97 [95% CI: 1.70–2.29]; 10-year absolute risk 3.6%) and kidney stones (HR = 1.69 [95% CI: 1.48–1.93]; 10-year absolute risk 5.6%) were also elevated. Risks were similar in Crohn's disease and ulcerative colitis.
Discussion: More than 10% of patients with inflammatory bowel disease (IBD) developed chronic kidney disease within 10-year from diagnosis, with many not being identified through diagnostic codes. This, together with their elevated acute kidney injury and kidney stone risks, highlights the need of established protocols for kidney function monitoring and referral to nephrological/urological care for patients with IBD.