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Inflammatory Bowel Diseases Are Associated With an Increased Risk for Chronic Kidney Disease, Which Decreases With
Ravy K Vajravelu1, Lawrence Copelovitch2, Mark T Osterman3
1Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Inflammatory bowel disease (IBD) is linked to a higher risk of chronic kidney disease (CKD), particularly in younger individuals. Common IBD medications like 5-aminosalicylates and methotrexate did not impact kidney function, while azathioprine showed a slight increase in eGFR.
Area of Science:
- Nephrology
- Gastroenterology
- Pharmacology
Background:
- The relationship between inflammatory bowel disease (IBD) and chronic kidney disease (CKD) risk is not fully understood.
- Previous studies inconsistently linked 5-aminosalicylates (5-ASAs) to increased CKD risk in IBD patients.
Purpose of the Study:
- To determine the relative hazard of CKD in IBD patients, adjusting for known risk factors.
- To investigate the association between IBD medications and changes in estimated glomerular filtration rate (eGFR).
Main Methods:
- A retrospective cohort study involving 17,807 IBD patients and 63,466 controls from The Health Improvement Network.
- Cox proportional hazards models were used to calculate CKD hazard ratios, adjusted for CKD risk factors.
- Longitudinal models assessed the association of 5-ASAs, azathioprine, and methotrexate with eGFR changes.
Main Results:
- IBD was associated with an increased risk of CKD (stages 3-5D) after controlling for risk factors.
- The adjusted hazard ratio for CKD decreased with increasing age, being highest in younger patients.
- Azathioprine was associated with a slight increase in eGFR, while 5-ASAs and methotrexate showed no association with eGFR change.
Conclusions:
- IBD is an independent risk factor for CKD, with the highest risk observed in younger IBD patients.
- Commonly prescribed non-biologic IBD medications (5-ASAs, methotrexate) are not associated with a decline in kidney function.
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.
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