Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2018; 24(42): 4798-4808
Published online Nov 14, 2018. doi: 10.3748/wjg.v24.i42.4798
Increased end-stage renal disease risk in patients with inflammatory bowel disease: A nationwide population-based study
Seona Park, Jaeyoung Chun, Kyung-Do Han, Hosim Soh, Kookhwan Choi, Ji Hye Kim, Jooyoung Lee, Changhyun Lee, Jong Pil Im, Joo Sung Kim
Seona Park, Jaeyoung Chun, Hosim Soh, Kookhwan Choi, Jong Pil Im, Joo Sung Kim, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Kyung-Do Han, Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Ji Hye Kim, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul 06135, South Korea
Jooyoung Lee, Changhyun Lee, Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, South Korea
Author contributions: Park S, Chun J and Han KD contributed in research conception and design; Park S, Han KD, Soh H, Choi K, Kim JH and Lee J contributed in data acquisition; Park S, Chun J, Han KD and Kim JS contributed in data analysis and interpretation; Han KD performed statistical analysis; Park S, Chun J and Kim JH contributed in drafting the manuscript; Lee C, Im JP and Kim JS contributed in critical revision of the manuscript; All authors approved the final manuscript.
Institutional review board statement: The study protocol was approved by the Seoul National University Hospital Institutional Review Board (H-1703-107-840).
Informed consent statement: All personal information was encrypted and all data were anonymous; therefore, we were not required to obtain informed consent from the study participants.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement-checklist of items, and the manuscript was prepared according to the STROBE statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joo Sung Kim, MD, PhD, Doctor, Professor, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul 06591, South Korea. jooskim@snu.ac.kr
Telephone: +82-2-7408112 Fax: +82-2-7436701
Received: August 20, 2018
Peer-review started: August 20, 2018
First decision: October 5, 2018
Revised: October 17, 2018
Accepted: October 21, 2018
Article in press: October 21, 2018
Published online: November 14, 2018
Processing time: 85 Days and 3.8 Hours
Abstract
AIM

To estimate the risk of end-stage renal disease (ESRD) in patients with inflammatory bowel disease (IBD).

METHODS

From January 2010 to December 2013, patients with Crohn’s disease (CD) and ulcerative colitis (UC) were identified, based on both the International Classification of Diseases, 10th revision (ICD-10) and the rare, intractable disease registration program codes from the National Health Insurance (NHI) database in South Korea. We compared 38812 patients with IBD to age- and sex-matched non-IBD controls with a ratio of 1:3. Patients newly diagnosed with ESRD were identified with the ICD-10 code.

RESULTS

During a mean follow-up of 4.9 years, ESRD was detected in 79 (0.2%) patients with IBD and 166 (0.1%) controls. The incidence of ESRD in patients with IBD was 0.42 per 1000 person-years. Patients with IBD had a significantly higher risk of ESRD than controls [adjusted hazard ratio (HR) = 3.03; 95% confidence interval (CI): 1.77-5.20; P < 0.001]. The incidences (per 1000 person-years) of ESRD were 0.51 in patients with CD and 0.13 in controls, respectively (adjusted HR = 6.33; 95%CI: 2.75-14.56; P < 0.001). In contrast, the incidence of ESRD was similar between the UC and control groups (0.37 vs 0.37 per 1000 person-years; adjusted HR = 2.01; 95%CI: 0.90-4.51; P = 0.089).

CONCLUSION

The risk of ESRD was elevated in patients with CD, but not UC. Patients with CD should be monitored carefully for signs of renal insufficiency.

Keywords: Claims data; Inflammatory bowel disease; Crohn’s disease; End-stage renal disease; Ulcerative colitis

Core tip: In this nationwide population-based study, we demonstrated that incidence of end-stage renal disease (ESRD) is significantly higher in patients with inflammatory bowel disease (IBD) compared to age- and sex-matched controls without IBD. To the best of our knowledge, this population-based study was the first to determine the incidence and risks of ESRD in patients with IBD. The incidence of ESRD in patients with Crohn’s disease (CD) was approximately 5 times higher compared to controls. Patients with CD are at a significant risk of developing ESRD regardless of age, sex, comorbidities. Our study provides new evidence for the association between ESRD and CD.