Diagnosis of Crohn’s Disease Linked to Chronic Kidney Disease Risk

Andres Rodriguez, DO, MBA

Credit: Twitter

Patients with inflammatory bowel disease (IBD), particularly Crohn’s Disease (CD), experience an increased risk of chronic kidney disease (CKD) development, according to new data presented at Digestive Disease Week (DDW) 2024.¹

The analysis of nearly 15,000 patients from a tertiary referral center over 12 years revealed a diagnosis of CKD was approximately 3-times more common among patients with CD than those with ulcerative colitis (UC).

“Patients with CD, especially those with kidney stones and previous intestinal resections, are at increased risk of CKD,” wrote the investigative team, led by Andres Rodriguez, DO, MBA, Emory University School of Medicine. "Indeed, an important proportion of these patients, 11%, needed kidney transplantation."

A significant global burden, the prevalence of IBD is most impactful in industrialized countries, including northern Europe and North America—the global incidence, however, is increasing and is driven by patients in newly industrialized countries.² Extraintestinal manifestations are observed in up to half of patients diagnosed with IBD.

Previous data have linked the presence of IBD to a range of kidney manifestations.³ However, the impact of both forms of IBD on kidney disease risk differs, with most studies reporting a higher risk of CKD in patients with CD.

Thus, a larger assessment of phenotypes of IBD patients may be critical to determine who is more likely to develop kidney disease so that targeted approaches can improve prevention and treatment outcomes.¹ For this analysis, the investigative team sought to identify IBD-specific risk factors that impacted the increased risk of CKD.

In doing so, Rodriguez and colleagues conducted a case-control population-based study from a tertiary referral center between 2010 and 2022. Inclusion criteria comprised only adults older than 18 —a patient’s IBD diagnosis was confirmed through a chart review of the Crohn’s and Colitis Center gastroenterology note.

Meanwhile, CKD was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria, showing estimated glomerular filtration rate (eGFR) values <60 mL/min/1.73 m2 for ≥3 months apart or with a history of end-stage renal disease requiring a kidney transplant.

A chart review was also performed for the phenotypic classification of patients, including IBD type, history of surgery, results from an endoscopy, and medication use. For each individual, the investigative team examined the Montreal Classification for CD and measured the extent of UC.

For the analysis, Rodriguez and colleagues performed a 1:1 matching of IBD cases with CKD to those without CKD, involving age, gender, and IBD type. Univariate analysis was performed using chi-squared tests and t-tests and a multivariable logistic regression model was fit for the analysis.

Altogether, the analysis identified 15,000 patients with UC or CD across the EPIC system. Confirmation of the correct IBD diagnosis and the presence of CKD left 124 patients for analysis, including 95 with CD and 29 with UC.

Upon analysis, Rodriguez and colleagues observed a CKD diagnosis was approximately three times more common for individuals with CD than UC. Given the limited sample size in UC, the team focused their efforts on the CD to determine the factors associated with CKD.

Across multivariable regression, those with kidney stones exhibited 8 times the likelihood of CKD than those without kidney stones. Individuals with ≥3 surgeries also exhibited 6 times the odds of CKD compared with patients without a history of surgery.

Moreover, a history of previous steroid use was linked with an elevated risk of CKD. On the other hand, those undergoing current immunomodulatory use demonstrated a 78% lower risk of CKD development than those not on immunomodulators.

Rodriguez and colleagues noted current mesalamine use was not associated with a greater likelihood of CKD—location of CD or Montreal phenotype also showed no association with kidney disease.

“It is our hope that these data will alert IBD clinicians to investigate decreased renal function in CD patients and address renal calculi in patients with CD,” Rodriguez and colleagues wrote.

References

1. _{Rodriguez A, Killian R, Quintero MA, Abreu MT. Determining the Factors Associated with Development of Chronic Kidney Disease in a Diverse IBD Population. Poster presented at Digestive Disease Week 2024, May 18 - 21, 2024.}
2. _{Dincer MT, Dincer ZT, Bakkaloglu OK, et al. Renal Manifestations in Inflammatory Bowel Disease: A Cohort Study During the Biologic Era. Med Sci Monit. 2022;28:e936497. Published 2022 Jul 6. doi:10.12659/MSM.936497}
3. _{Liu M, Zhang Y, Ye Z, et al. Inflammatory Bowel Disease With Chronic Kidney Disease and Acute Kidney Injury. Am J Prev Med. 2023;65(6):1103-1112. doi:10.1016/j.amepre.2023.08.008}