Inflammatory bowel disease increases risk of chronic kidney disease and acute kidney injury

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic, nonspecific intestinal inflammatory disease characterized by recurrent inflammation and intestinal epithelial damage. In addition to intestinal manifestations, IBD patients may also experience a variety of extraintestinal manifestations affecting multiple organ systems, leading to multiple complications and sometimes even life-threatening. Previous studies have shown that IBD is associated with a range of renal manifestations, including kidney stones, glomerulonephritis, tubulointerstitial nephritis, and secondary amyloidosis, which may lead to acute or chronic renal insufficiency. However, to date, the relationship between IBD and new-onset chronic kidney disease is unclear, and no studies have evaluated the association between IBD and acute kidney injury.

In response to the above clinical problems, the National Clinical Research Center for Kidney Diseases of Nanfang Hospital, Southern Medical University, has conducted relevant work, and the research results were recently published in the American Journal of Preventive Medicine . The study found that IBD patients have a significantly increased risk of chronic kidney disease and acute kidney injury, and this association is not affected by genetic susceptibility to kidney disease . Professor Qin Xianhui of the National Clinical Research Center for Kidney Diseases of Nanfang Hospital, Southern Medical University is the corresponding author of the article, and Dr. Liu Mengyi is the first author.

The study included more than 410,000 middle-aged and elderly participants from the UK Biobank study who were free of chronic kidney disease and acute kidney injury at baseline. IBD patients (including UC and CD) were the exposed group, and non-IBD subjects were the non-exposed group.

At baseline, 4201 participants were diagnosed with IBD, of whom 1261 and 2940 were diagnosed with CD and UC, respectively. During an average follow-up of 12.5 years, 13,564 and 14,331 participants developed new-onset chronic kidney disease and acute kidney injury, respectively. The study showed that:

(1) Compared with participants without IBD, the risk of chronic kidney disease and acute kidney injury in IBD patients increased significantly by 32% and 70%, respectively, in CD patients increased significantly by 38% and 62%, respectively, and in UC patients increased significantly by 29% and 71%, respectively.

(2) Regardless of whether the participants had a high or low genetic susceptibility to kidney disease, IBD patients had a significantly increased risk of kidney disease and acute kidney injury (Figure 1);

Figure 1 Association of IBD with the risk of chronic kidney disease and acute kidney injury in subjects with different genetic risks for kidney disease

(3) The association between IBD and chronic kidney disease and acute kidney injury is more evident in younger subjects than in older subjects.

In conclusion, this large prospective study showed that patients with IBD have a significantly increased risk of chronic kidney disease and acute kidney injury, and this association is not modified by genetic susceptibility to kidney disease. This study emphasizes the need and importance of monitoring the trajectory of kidney function in patients with IBD.

Information Points

Currently, more than 10 million people worldwide suffer from IBD. It is estimated that by 2025, the total number of IBD patients in China will reach 1.5 million. In the past, IBD patients were mainly adolescents; in recent years, the incidence and prevalence of IBD in the elderly are steadily increasing, and the IBD patient population is aging, accompanied by more chronic comorbidities and multiple medications, which brings more challenges to the diagnosis and management of diseases in the elderly.

The picture is from the Internet, the copyright belongs to the original author

May 19th of each year is World Inflammatory Bowel Disease (IBD) Day, which aims to arouse public attention to IBD, a chronic, disabling disease, and the global patient population, and enhance the public's correct understanding of IBD. The theme of World IBD Day in 2023 is "Inflammatory Bowel Disease Knows No Age", and it specifically calls for continued attention to the elderly IBD population.

References:

Liu M, Zhang Y, Ye Z, Yang S, Zhou C, He P, Zhang Y, Hou FF, Qin X. Inflammatory Bowel Disease With Chronic Kidney Disease and Acute Kidney Injury. Am J Prev Med. 2023 Aug 10: S0749-3797(23)00319-7.

Editor | Liu Mengyi Huang Yu

Audit | Qin Xianhui