# Poster Session II - A233 INFLAMMATORY BOWEL DISEASE IS ASSOCIATED WITH AN INCREASED RISK OF END-STAGE RENAL DISEASE: A POPULATION-BASED COHORT STUDY

## TL;DR

People with inflammatory bowel disease are at higher risk of developing end-stage renal disease compared to the general population.

## Contribution

This study identifies IBD as an independent risk factor for ESRD and highlights specific predictors within IBD patients.

## Key findings

- IBD patients had a 1.48% incidence of dialysis compared to 0.82% in controls.
- Crohn’s disease showed a stronger association with ESRD than ulcerative colitis.
- Oral steroids, allopurinol use, and bowel surgery were significant predictors of dialysis initiation in IBD patients.

## Abstract

Inflammatory bowel disease (IBD) patients frequently develop extraintestinal manifestations, including renal complications. However, the incidence and risk factors for end-stage renal disease (ESRD) in IBD remain poorly characterized.

This study aims to assess the incidence of ESRD in IBD, compare its risk with the general population, and identify predictors of ESRD.

This was a retrospective population-based cohort study using the University of Manitoba IBD Epidemiology Database linked to administrative healthcare data from 1984-2023 (12,639 IBD patients matched with 126,180 controls). ESRD was defined as requiring any two claims for outpatient dialysis within a 1-year period. Predictive factors were identified using proportional hazard regression and nested case-control logistic regression analyses.

A233 Table 1: Baseline characteristic of all participants in cohort

IBD patients had significantly higher incidence of dialysis (1.48% vs 0.82%, p < 0.0001) and kidney transplantation (0.25% vs 0.10%, p < 0.0001) than controls. IBD was an independent predictor of ESRD (HR = 1.53, 95% CI 1.23-1.90), with stronger associations in CD (HR = 1.93, 95% CI 1.39-2.68) than UC (HR = 1.28, 95% CI 0.96-1.72). Traditional risk factors including diabetes (HR = 3.82, 95% CI 3.22-4.53), hypertension (HR = 1.91, 95% CI 1.58-2.30), and congestive heart failure (HR = 6.37, 95% CI 5.25-7.72) remained strongly predictive. Within the IBD population, oral steroid treatment (OR = 2.0, 95%CI 1.06-3.81), allopurinol use (OR = 4.06, 95% CI 1.49-11.1), and bowel surgery (OR = 2.77, 95% CI 1.51-5.09) significantly predicted dialysis initiation

IBD increases ESRD risk by nearly 50%, with CD showing greater risk than UC. Bowel surgery, allopurinol use, and oral steroid therapy are important predictors, emphasizing the necessity of careful renal monitoring in IBD patients.

Kaplan–Meier survival curves showing the cumulative incidence of all-cause ­mortality during follow-up among patients with Crohn’s disease (CD), ulcerative colitis (UC), and controls after initiation of dialysis.

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