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Abstract: PO2385

Incident Biologic Use and Risk of ESKD in Patients with Inflammatory Bowel Disease

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Gyamlani, Geeta G., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Dashputre, Ankur A., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Inflammatory bowel disease (IBD) is associated with reduced kidney function, possibly due to chronic inflammation or the use of nephrotoxic therapies. Little is known about the effects of IBD therapy using novel biologic agents on the risk of incident end-stage kidney disease (ESKD).

Methods

In a nationwide cohort of 66,602 US veterans with an eGFR ≥60 mL/min/1.73m2 from 2004-2006 who were newly diagnosed with IBD (at least 2 IBD diagnoses that were 30-365 days apart) during follow-up through 2018, we examined the association of incident biologic use (as a time-dependent exposure) with incidence of ESKD, using time-dependent Cox models adjusted for sociodemographics, smoking and alcohol use, comorbidities, eGFR, vital signs, and relevant medications (e.g., antihypertensives, NSAIDs, steroids, nonbiologic DMARDs).

Results

Patients were 69±11 years old; 93% were male; 7.4% were African American; 30% were diabetic; and baseline eGFR was 77±16 mL/min/1.73m2. Among 66,602 patients, 1,047 (1.6%) started biologic therapy, and 504 (0.8%) experienced an incident ESKD. In a sociodemographic-adjusted model, incident biologic use (vs. non-use) was associated with lower risk of incident ESKD (adjusted HRs [95%CI], 0.55 [0.20-1.49], in model 1) albeit not reaching statistical significance. This association was attenuated after further multivariable adjustment (0.98 [0.41-2.35], in model 4; Figure).

Conclusion

Biologic agent administration is not associated with higher risk of incident ESKD. Clinical trials are warranted to test whether active interventions with biologic agents are safe and effective in preventing adverse renal outcomes associated with IBD.

Funding

  • Veterans Affairs Support