Increased Risk of End-stage Renal Disease in Patients with Inflammatory Bowel Disease : A Nationwide Population-based Study

Abstract

Background/Aim: The association between end-stage renal disease (ESRD) and inflammatory bowel disease (IBD) remains unclear. We investigated the risk of ESRD among patients with IBD using a nationwide population-based claim data. Methods: We conducted a retrospective cohort study using data from the National Health Insurance (NHI), a mandatory health insurance program covering about 97% of the Korean population. From 2010 to 2013, patients with Crohns disease (CD) and Ulcerative colitis (UC) who were registered in the NHI data were identified through both ICD-10 codes (K50 and K51) and the rare/intractable disease registration program codes which provide co-payment reduction of up to 90% in Korea. We compared 38,812 IBD patients with non-IBD age and sex-matched individuals with a ratio of 1:3. Patients who were newly diagnosed with ESRD were identified through ICD-10 code. The Kaplan–Meier method was used to estimate the cumulative probability of ESRD in patients with IBD. Results: The study participants with IBD comprised 23,680 male (61.0%), and the mean age was 40.0 years. IBD was significantly associated with high income, urban residence, high prevalence of congestive heart failure, ischemic heart disease, hyperuricemia and gout, and low prevalence of diabetes, hypertension, dyslipidemia. During a mean follow-up of 4.9 years, ESRD was newly detected in 79 (0.2%) of the IBD group and 166 (0.1%) of the controls, respectively. The incidence rate of ESRD in patients with IBD was 0.42 per 1,000 person-years. The adjusted risk of ESRD in patients with IBD was significantly higher compared to control group (adjusted hazard ratio [HR], 1.67

95% confidence interval [CI] , 1.27–2.18

p<0.001). Among patients with CD, incidence rate (per 1,000 person-years) of ESRD was 0.51, compared to 0.13 in controls (adjusted HR, 3.98

95% CI, 2.31-6.85

p<0.001). However, there was no significant difference in incidence rate of ESRD between UC and control groups (0.37 vs. 0.37 per 1,000 person-years

adjusted HR, 1.22

95% CI, 0.88-1.70

p=0.307). The impact of CD on ESRD significantly increased in patients without any metabolic disease including diabetes, hypertension and dyslipidemia (adjusted HR, 10.08

95% CI, 3.28-30.97), compared to those with metabolic diseases (adjusted HR, 3.13

95% CI, 1.65-5.92

p=0.074 by interaction analysis). Conclusion: The risk of ESRD increased in patients with CD, but not UC. Patients with CD should be monitored carefully for the development of renal insufficiency, especially in those without metabolic syndrome.