Inflammatory Bowel Disease Associated with Progression to End-Stage Kidney Disease

Credit: Sora Shimazaki/Unsplash

Approximately one-quarter of patients with kidney disease associated with inflammatory bowel disease (IBD) progress to end-stage kidney disease, according to new research presented at American Society of Nephrology (ASN) Kidney Week 2023, in Philadelphia, Pennsylvania.¹

The data, involving more than 100 patients with IBD, suggested the primary determinants of the progression to end-stage kidney disease included the age, baseline estimated glomerular filtration rate (eGFR), and degree of chronicity in kidney biopsy.

“Global survival (end-stage kidney disease plus death) was significantly better in patients who achieved complete/partial recovery of kidney function,” wrote the investigative team, led by Federico Yandian, department of nephrology, Hospital de Clínicas "Dr Manuel Quintela”.

An umbrella term, IBD includes both Crohn’s disease and ulcerative colitis.² Among those diagnosed with IBD, extraintestinal manifestations are observed in 6% to 47% of patients. Kidney disease is a well-recognized extraintestinal manifestation associated with IBD, but there are different underlying etiologies. However, there is a dearth of knowledge about the overall outcome and predictors.

The retrospective, observational, cohort study included patients with a previous diagnosis of IBD in whom a kidney biopsy was performed at the Mayo Clinic between 1994 to 2022.¹ However, kidney transplant patients were excluded from the study. The main outcomes for the study were kidney failure (defined as eGFR <15mL/min/1.73 m²) and kidney function recovery at the last follow-up (categorized as ≥75%, 25–75%, <25% of baseline eGFR).

Among a total cohort of 318 patients, 111 patients with IBD and available long-term follow-up were selected (45 ulcerative colitis and 66 Crohn’s disease), with a mean age of 48 years. The study population consisted of 40% female patients. A total of 68 (61%) patients were under treatment with 5-ASA.

In the analysis, IgA nephropathy, chronic interstitial nephritis, and acute interstitial nephritis were the most common diagnoses (22%, 19%, 13%). Median eGFR at presentation was 30 ml/min/1.73 m² and urinary protein-to-creatinine ratio (0.8 g/g), with no differences between types of IBD. Over the median follow-up of 59 months, 29 (26%) patients progress to end-stage kidney disease.

According to multivariable cox regression analysis, the main predictors of kidney failure were age (hazard ratio [HR], 1.04; P = .002), baseline eGFR (HR, 0.94; P = .003), and histologic total chronicity score (HR, 4.01; P <.001).

A total of 26 (24%), 19 (17%), and 66 (59%) achieved complete, partial, or no remission or recovery of kidney function, respectively. Overall, the analysis revealed global survival was significantly better in patients who achieved complete or partial recovery of kidney function.

References

1. _{Yandian F. Caraveca-Fontan F. Herrera Hernandez LP. Soler MJ. Sethi S. Fervenza FC. Kidney Diseases Associated with Inflammatory Bowel Disease. Poster presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.}
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}