Colectomy & kidney disease

June 24, 2024

Issue 13

Clinical Question

Does colectomy increase the risk of kidney disease in IBD?

Editor’s Bottom Line

Although residual confounding by disease activity and medication exposure cannot be excluded, these observational data suggest an association between colectomy and kidney disease in IBD patients. IBD clinicians should consider regular monitoring of renal function.

Reference

Yang Y, Ludvigsson JF, Forss A, et al. Risk of Kidney Failure in Patients With Inflammatory Bowel Disease Undergoing Colectomy: A Nationwide Cohort Study. Clin Gastroenterol Hepatol. Epub ahead of print May 20, 2024. https://www.cghjournal.org/article

Synopsis

Armed with a hypothesis that colectomy increases the risk of acute kidney injury (AKI) and chronic kidney failure in patients with IBD, American and Swedish researchers analyzed data from 82,051 individuals diagnosed with IBD between 1965 and 2017. The data were derived from the Epidemiology Strengthened by histopathology Reports in Sweden (ESPRESSO) cohort and included a median 14 years of patient follow-up, with the most recent data collection in 2019.

Patients were a mean 40 years of age at the time of registry enrollment and were divided roughly evenly by sex. In terms of baseline risk factors for renal complications, 6.1% had hypertension, 2.8% had diabetes and 0.7% had a chronic kidney disease.

During the study period, 20.1% of individuals underwent colectomy, including 7,672 partial colectomies and 8,807 total colectomies. Surgeries were performed a median 3.4 years after IBD diagnosis, when patients were a mean 43 years of age. There were 2,556 instances of AKI and 1,146 kidney failure diagnoses during the study.

Statistical analyses found colectomy was associated with a significantly increased risk of both AKI (adjusted Hazard Ratio [aHR]: 2.37; 95% Confidence Interval [CI], 2.17–2.58) and chronic kidney failure (aHR: 1.54; 95% CI, 1.34–1.76). While the heightened risk was present for both IBD subtypes, it was more pronounced in the ulcerative colitis group (aHR for AKI for UC and CD: 2.88 and 1.76, respectively; aHR for kidney failure for UC and CD: 1.71 and 1.09, respectively).

The risk of post-colectomy renal complications was higher among those who underwent total colectomy (aHR for AKI for total and partial colectomy: 2.98 and 1.65, respectively, and aHR for kidney failure for total and partial colectomy: 1.89 and 1.19, respectively).

The risk of both AKI and kidney failure was highest in the 6–12 months after colectomy. The risk of AKI remained elevated for the duration of follow-up.

Details

Study Design: Retrospective nationwide cohort
Funding: The Swedish Research Council, The National Institute of Health and the Marin Rind Foundation
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b