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. 2020 Sep;18(10):2262-2268.
doi: 10.1016/j.cgh.2019.10.043. Epub 2019 Nov 1.

Inflammatory Bowel Diseases Are Associated With an Increased Risk for Chronic Kidney Disease, Which Decreases With Age

Ravy K Vajravelu  1 , Lawrence Copelovitch  2 , Mark T Osterman  3 , Frank I Scott  4 , Ronac Mamtani  5 , James D Lewis  6 , Michelle R Denburg  7
Affiliations

Inflammatory Bowel Diseases Are Associated With an Increased Risk for Chronic Kidney Disease, Which Decreases With Age

Ravy K Vajravelu et al. Clin Gastroenterol Hepatol. 2020 Sep.

Abstract

Background & aims: It is not clear what factors affect risk of chronic kidney disease (CKD) in patients with inflammatory bowel disease (IBD); increased risk has been inconsistently associated with use of 5-aminosalicylates (5-ASAs). We aimed to calculate the relative hazard of CKD among patients with IBD, adjusted for CKD risk factors, and to determine whether IBD medications are associated with change in estimated glomerular filtration rate (eGFR).

Methods: We performed a retrospective cohort study of data from The Health Improvement Network. Patients with IBD (n = 17,807) were matched for age, sex, and practice to individuals without IBD (n = 63,466). The relative hazard of CKD, stages 3 through 5D, in patients with IBD was calculated using a Cox proportional hazards model adjusted for common CKD risk factors. We also evaluated the association of 5-ASAs, azathioprine, and methotrexate with change in eGFR using a longitudinal model.

Results: After we controlled for risk factors associated with CKD, we found IBD to be associated with development of CKD in patients 16-77 years old. As patient age increased, the adjusted hazard ratio for CKD decreased monotonically, from 7.88 (95% CI, 2.56-24.19) at age 16 to 1.13 (95% CI, 1.01-1.25) at age 77. In the longitudinal analysis, exposure to 5-ASAs or methotrexate was not associated with change in eGFR, whereas azathioprine was associated with a slightly higher eGFR (0.32 mL/min/1.73 m2; 95% CI, 0.16-0.48).

Conclusions: In a retrospective study of more than 80,000 persons, we found that IBD is associated with increased risk of CKD, and the hazard ratio is highest among younger patients. Commonly used non-biologic therapeutic agents were not associated with lower eGFR.

Keywords: 5-Aminosalicylates; Chronic Kidney Disease; Inflammatory Bowel Disease.

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Figures

Figure 1.
Figure 1.
Unadjusted incidence rate ratios by age of persons with IBD and matched individuals without IBD. Solid lines represent smoothed lines of best fit.
Figure 2.
Figure 2.
Adjusted hazard ratio of IBD by age (black solid line). Gray shaded area represents 95% confidence intervals. Horizontal dashed line indicates adjusted hazard ratio = 1. Vertical dotted line indicates quadratic spline at age 60. 95% confidence interval crosses 1 at age 78. Graph left-truncated at age 16 because no diagnoses of CKD occurred before this age. Adjusted hazard ratio values are presented in Supplementary Table 4.
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Comment in

  • Reply.
    Vajravelu RK, Copelovitch L, Denburg MR. Vajravelu RK, et al. Clin Gastroenterol Hepatol. 2021 Sep;19(9):1994. doi: 10.1016/j.cgh.2020.11.031. Epub 2020 Nov 20. Clin Gastroenterol Hepatol. 2021. PMID: 33227429 No abstract available.
  • Link Between Inflammatory Bowel Disease and Risk of Chronic Kidney Disease.
    Wang CY, Chen WL, Cheng-Chung Wei J. Wang CY, et al. Clin Gastroenterol Hepatol. 2021 Sep;19(9):1993-1994. doi: 10.1016/j.cgh.2020.10.040. Epub 2020 Nov 26. Clin Gastroenterol Hepatol. 2021. PMID: 33248103 No abstract available.

References

    1. Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, et al. Long-term complications, extraintestinal manifestations, and mortality in adult Crohn’s disease in population-based cohorts. Inflamm Bowel Dis 2011;17:471–478. - PubMed
    1. Van Staa TP, Travis S, Leufkens HGM, et al. 5-aminosalicylic acids and the risk of renal disease: a large British epidemiologic study. Gastroenterology 2004;126:1733–1739. - PubMed
    1. Lewis B, Mukewar S, Lopez R, et al. Frequency and risk factors of renal insufficiency in inflammatory bowel disease inpatients. Inflamm Bowel Dis 2013;19:1846–1851. - PubMed
    1. Primas C, Novacek G, Schweiger K, et al. Renal insufficiency in IBD: prevalence and possible pathogenetic aspects. J Crohns Colitis 2013;7:e630–e634. - PubMed
    1. Bernstein CN, Wajda A, Blanchard JF. The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. Gastroenterology 2005;129:827–836. - PubMed

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