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Kidney Week

Abstract: TH-PO598

Kidney Diseases Associated with Inflammatory Bowel Disease

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Yandian, Federico, Department of Nephrology, Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay
  • Caravaca-Fontan, Fernando, Instituto de Investigación Hospital “12 de Octubre”, Madrid, Spain
  • Herrera Hernandez, Loren Paola, Mayo Clinic Department of Laboratory Medicine and Pathology, Rochester, Minnesota, United States
  • Soler, Maria Jose, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
  • Sethi, Sanjeev, Mayo Clinic Department of Laboratory Medicine and Pathology, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
Background

Kidney disease is a well-known extra-intestinal manifestation associated with intestinal bowel disease (IBD), with different underlying etiologies. Little is known about the overall outcomes and predictors.

Methods

Retrospective, observational, cohort study. Patients with previous diagnosis of IBD in whom a kidney biopsy was performed at Mayo Clinic between 1994–2022, were included. Kidney transplant patients were excluded. The main outcomes were kidney failure (defined as eGFR<15 ml/min/1.73m2) and kidney function recovery at last follow-up (categorized as ≥75%, 25–75%, <25% of baseline eGFR).

Results

From a total cohort of 318 patients, 111 patients with IBD and long-term follow-up available were selected (45 ulcerative colitis and 66 Crohn’s disease), with a mean age 48±17 years (40% females). Sixty-eight (61%) were under treatment with 5-ASA. IgA nephropathy, chronic interstitial nephritis and acute interstitial nephritis were the most common diagnoses (22%, 19%, 13%). Median eGFR at presentation was 30 [IQR17–54] ml/min/1.73m2 and urinary protein-to-creatinine ratio 0.8 [0.3–3.4] g/g, with no differences between type of IBD. During a median follow-up of 59 (12–109) months, 29 (26%) patients progress to end-stage kidney disease (ESKD). By multivariable Cox regression analysis, the main predictors of kidney failure were age (HR: 1.04; p=0.002), baseline eGFR (HR: 0.94; p=0.003) and histologic total chronicity score (HR: 4.01; p<0.001). 26 (24%), 19 (17%), and 66 (59%) achieved complete, partial or no remission/recovery of kidney function, respectively. Global survival (ESKD+death) was significantly better in patients who achieved complete/partial recovery of kidney function.

Conclusion

One-fourth of patients with kidney disease associated with IBD progress to ESKD, and the main determinants of this outcome is age, baseline eGFR and degree of chronicity in kidney biopsy.