Related Experiment Video
Updated: Sep 17, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Prescribing Inflammatory Bowel Disease Medications in Chronic Kidney Disease: A Practical Guide
Lynna Chen1,2, Ashish Srinivasan1,2,3, Suet-Wan Choy2,3,4
1Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.
Insights
Most inflammatory bowel disease (IBD) therapies, especially biologics, are safe for patients with chronic kidney disease (CKD). Conventional treatments and Janus kinase (JAK) inhibitors require careful consideration and dose adjustments in advanced CKD.
Area of Science:
- Nephrology
- Gastroenterology
- Pharmacology
Background:
- Increasing prevalence of chronic kidney disease (CKD) in inflammatory bowel disease (IBD) patients.
- Limited pharmacokinetic data for IBD medications in advanced CKD.
Purpose of the Study:
- Provide evidence-based guidance for managing IBD patients with CKD.
- Focus on medical therapies in advanced kidney disease and renal replacement therapy.
Main Methods:
- Narrative literature review up to March 2025.
- Focused on therapies for IBD in the context of CKD and renal replacement therapy.
Main Results:
- Mesalazine and calcineurin inhibitors carry renal risks.
- Methotrexate is contraindicated in advanced renal disease; thiopurines require dose adjustment.
- Biologics (anti-TNF, anti-integrin, anti-IL-12/23) appear safe in CKD, including hemodialysis.
- Small molecule therapies generally safe; JAK inhibitors (tofacitinib, upadacitinib) need dose reduction in advanced CKD.
Conclusions:
- Biologic therapies are largely safe and effective for IBD patients with CKD, including those on renal replacement therapy.
- Conventional therapies and JAK inhibitors warrant caution and potential dose modification in CKD patients.
Background:
The prevalence of chronic kidney disease (CKD) in patients with inflammatory bowel disease (IBD) is increasing. The pharmacokinetic profiles of IBD medications in patients with advanced-stage CKD are not well studied.
Aim:
To provide evidence-based guidance on the use of medical therapies in patients with IBD and CKD.
Methods:
We conducted a narrative review of literature up to 31 March 2025 on studies of therapies currently used for the treatment of IBD in the setting of CKD, with a focus on advanced kidney disease and use in renal replacement therapy.
Results:
Mesalazine can cause acute interstitial nephritis. Calcineurin inhibitors have been associated with nephrotoxicity. Methotrexate is contraindicated in advanced renal disease, including while on renal replacement therapy, due to higher risks of toxicity and myelosuppression. Dose adjustment of thiopurines should be considered in advanced renal disease due to metabolite accumulation. Monoclonal antibodies, including anti-tumour necrosis factor therapy, anti-integrin therapy and anti-interleukin 12/23 therapies, appear to be safe in renal insufficiency, including haemodialysis. There is limited data available for small molecule therapies; drug metabolism profiles suggest they are safe in CKD, although, for Janus kinase (JAK) inhibitors, including tofacitinib and upadacitinib, dose reduction should be considered in advanced renal disease.
Conclusion:
Most therapies used in IBD, particularly biologic therapies, appear safe and effective when used in patients with CKD, including those on renal replacement therapy. Caution should be considered when using conventional therapies and JAK inhibitors.
Related Concept Videos
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:28Chronic Kidney Disease III: Interprofessional Care
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:18Chronic Kidney Disease IV: Nursing Management