Increased end-stage renal disease risk in patients with inflammatory bowel disease: A nationwide population-based study

Table 1 Baseline characteristics of the study population of patients without (control) or with inflammatory bowel disease n (%)

	IBD			CD			UC
	Non-IBD control (n = 116436)	IBD cohort (n = 38812)	P value	Non-CD control (n = 37755)	CD cohort (n = 12585)	P value	Non-UC control (n = 78681)	UC cohort (n = 26227)	P value
Age, yr1	40.0 ± 16.7	40.0 ± 16.7	-	30.7 ± 14.6	30.7 ± 14.6	-	44.4 ± 15.8	44.4 ± 15.8	-
< 15	3639 (3.1)	1213(3.1)		2562 (6.8)	854 (6.8)		1077 (1.4)	359 (1.4)
15-39	56679 (48.7)	18893 (48.7)		26577 (70.4)	8859 (70.4)		30102 (38.3)	10034 (38.3)
≥ 40	56118 (48.2)	18706 (48.2)		8616 (22.8)	2872 (22.8)		47502 (60.4)	15834 (60.4)
Male gender	71040 (61.0)	23680 (61.0)	-	26451 (70.1)	8817 (70.1)	-	44589 (56.7)	14863 (56.7)	-
Rural residence	62045 (53.3)	19312 (49.8)	< 0.001	20043 (53.1)	6163 (49.0)	< 0.001	42002 (53.4)	13149 (50.1)	< 0.001
Lowest income 20%2	33008 (28.4)	9316 (24.0)	< 0.001	10705 (28.4)	3229 (25.7)	< 0.001	22303 (28.6)	6087 (23.2)	< 0.001
DM	5786 (5.0)	1612 (4.2)	< 0.001	845 (2.3)	280 (2.2)	0.931	4941 (6.3)	1332 (5.1)	< 0.001
Hypertension	14958 (12.9)	4494 (11.6)	< 0.001	2294 (6.1)	665 (5.3)	0.001	12664 (16.1)	3829 (14.6)	< 0.001
Dyslipidemia	8620 (7.4)	2718 (7.0)	0.009	1358 (3.6)	376 (3.0)	0.001	7262 (9.2)	2342 (8.9)	0.145
Congestive heart failure	781 (0.7)	356 (0.9)	< 0.001	119 (0.3)	85 (0.7)	< 0.001	662 (0.8)	271 (1.0)	0.004
Ischemic heart disease	4028 (3.5)	1747 (4.5)	< 0.001	616 (1.6)	381 (3.0)	< 0.001	3412 (4.3)	1366 (5.2)	< 0.001
Gout and/or hyperuricemia	1552 (1.3)	650 (1.7)	< 0.001	320 (0.9)	211 (1.7)	< 0.001	1232 (1.6)	439 (1.7)	< 0.001
Medications for IBD
5-ASA	121 (0.1)	36288 (93.5)	< 0.001	32 (0.1)	11233 (89.3)	< 0.001	89 (0.1)	25055 (95.5)	< 0.001
Corticosteroids	0 (0.0)	22284 (57.4)	< 0.001	0 (0.0)	7382 (58.7)	< 0.001	0 (0.0)	14902 (56.8)	< 0.001
Immunomodulators	0 (0.0)	10356 (26.7)	< 0.001	0 (0.0)	6982 (55.5)	< 0.001	0 (0.0)	3374 (12.9)	< 0.001
Anti-TNF-α	0 (0.0)	2103 (5.4)	< 0.001	0 (0.0)	1659 (13.2)	< 0.001	0 (0.0)	444 (1.7)	< 0.001
Follow-up period, yr1	4.9 ± 1.3	4.9 ± 1.3	0.337	4.9 ± 1.3	4.9 ± 1.3	0.004	4.9 ± 1.3	4.9 ± 1.3	0.418

¹Mean ± SD;

²Defined as patients whose income was in the bottom 20%. ASA: Aminosalicylic acid; CD: Crohn’s disease; DM: Diabetic mellitus; IBD: Inflammatory bowel disease; TNF: Tumor necrosis factor; UC: Ulcerative colitis.

Table 2 Incidence and risk of end-stage renal disease in patients with inflammatory bowel diseases

	Total No. (n)	ESRD cases (n)	Person-years	ESRD incidence (per 1000 person-years)	Crude HR (95%CI)	P value	Model 11 HR (95%CI)	P value	Model 22 HR (95%CI)	P value	Model 33 HR (95%CI)	P value
Total IBD						0.009		0.009		< 0.001		< 0.001
Non-IBD control	116436	166	568575	0.29	1 (reference)		1 (reference)		1 (reference)		1 (reference)
IBD cohort	38812	79	189245	0.42	1.43 (1.09-1.87)		1.43 (1.09-1.87)		1.67 (1.27-2.18)		3.03 (1.77-5.20)
IBD subgroup						0.013		0.004		< 0.001		< 0.001
Non-IBD control	116436	166	568575	0.29	1 (reference)		1 (reference)		1 (reference)		1 (reference)
Incident IBD group	16606	32	65646	0.49	1.71 (1.17-2.50)		1.89 (1.29-2.73)		1.72 (1.17-2.52)		3.06 (1.71-5.47)
Prevalent IBD group	22206	47	123600	0.38	1.29 (0.93-1.78)		1.23 (0.89-1.70)		1.63 (1.18-2.27		3.01 (1.67-5.43)

¹Model 1: adjusted for age and sex;

²Model 2: adjusted for model 1 + place of residence, income, diabetes mellitus, hypertension, dyslipidemia, congestive heart failure, ischemic heart disease, and gout and/or hyperuricemia;

³Model 3: adjusted for model 2 + medication use (5-aminosalicylic acid, corticosteroids, immunomodulators, and anti-tumor necrosis factor -α agents). CI: Confidence interval; ESRD: End-stage renal disease; HR: Hazard ratio; IBD: Inflammatory bowel disease; No: Number.

Table 3 Incidence and risk of end-stage renal disease in patients with Crohn’s disease and ulcerative colitis

	Total No. (n)	ESRD cases (n)	Person-years	ESRD incidence (per 1000 person-years)	Crude HR (95%CI)	P value	Model 11 HR (95%CI)	P value	Model 22 HR (95%CI)	P value	Model 33 HR (95%CI)	P value
Total CD						< 0.001		< 0.001		< 0.001		< 0.001
Non-CD control	37755	24	184988	0.13	1 (reference)		1 (reference)		1 (reference)		1 (reference)
CD cohort	12585	31	61189	0.51	3.90 (2.29-6.65)		4.00 (2.35-6.82)		3.98 (2.31-6.85)		6.33 (2.75-14.56)
CD subgroup						< 0.001		< 0.001		< 0.001		< 0.001
Non-CD control	37755	24	184988	0.13	1 (reference)		1 (reference)		1 (reference)		1 (reference)
Incident CD group	5586	14	21836	0.64	4.92 (2.53-9.57)		5.18 (2.66-10.07)		4.21 (2.12-8.35)		6.30 (2.56-15.26)
Prevalent CD group	6999	17	39353	0.43	3.34 (1.79-6.23)		3.37(1.81-6.29)		3.81(2.03-7.16)		6.38 (2.47-16.47)
Total UC						0.941		0.961		0.307		0.089
Non-UC control	78681	142	383587	0.37	1 (reference)		1 (reference)		1 (reference)		1 (reference)
UC cohort	26227	48	128056	0.37	1.01 (0.73-1.40)		1.01 (0.73-1.40)		1.22 (0.88-1.70)		2.01 (0.90-4.51)
UC subgroup						0.821		0.821		0.513		0.235
Non-UC control	78681	142	383587	0.37	1 (reference)		1 (reference)		1 (reference)		1 (reference)
Incident UC group	11020	18	43810	0.41	1.14 (0.70-1.87)		1.27 (0.77-2.08)		1.19 (0.73-1.96)		1.99 (0.83-4.80)
Prevalent UC group	15207	30	84247	0.36	0.95 (0.64-1.41)		0.90 (0.61-1.33)		1.24 (0.83-1.84)		2.03 (0.87-4.72)

¹Model 1: adjusted for age and sex;

²Model 2: adjusted for model 1 + region, income, diabetes mellitus, hypertension, dyslipidemia, congestive heart failure, ischemic heart disease, gout and/or hyperuricemia;

³Model 3: adjusted for model 2 + medication use (5-aminosalicylic acid, corticosteroids, immunomodulators, and anti-tumor necrosis factor -α agents). CD: Crohn’s disease; CI: Confidence interval; ESRD: End-stage renal disease; HR: Hazard ratio; No: Number; UC: Ulcerative colitis.