Risk of acute kidney injury in hospitalized patients with inflammatory bowel disease: a systematic review and meta-analysis

Objectives: Inflammatory bowel disease (IBD) is associated with a range of extraintestinal manifestations, including renal complications. While chronic kidney disease in IBD is well described, the risk of acute kidney injury (AKI) remains less well quantified. We aimed to evaluate the risk of AKI among hospitalized patients with IBD compared to non-IBD populations, and to assess this risk across clinical subgroups. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered the protocol with PROSPERO. A comprehensive search of PubMed, MEDLINE, Embase, Scopus, and Cochrane CENTRAL was conducted from inception to June 2025. Eligible studies included cohort, case-control, and randomized control trials reporting on AKI outcomes in IBD versus non-IBD comparators. Meta-analyses were performed using random-effects models. Subgroup analyses were conducted by surgical status, infection, acute coronary syndrome, and general hospitalization. Results: Seventeen retrospective cohort studies involving 20 127 976 patients (140 482 with IBD) were included. IBD was associated with significantly increased odds of AKI (pooled odds ratio [OR]: 1.87; 95% confidence interval [CI], 1.53-2.29). The association was especially prominent in surgical patients (OR: 2.17; 95% CI, 1.73-2.73), including orthopedic (OR: 2.22; 95% CI, 1.50-3.30) and spinal (OR: 2.15; 95% CI, 1.66-2.78) subgroups. Associations in acute coronary syndrome and infection subgroups were less consistent. ROBINS-E (Risk Of Bias In Non-randomized Studies-of Exposures) assessments revealed a moderate risk of bias. Conclusions: A diagnosis of IBD is potentially associated with the development of AKI, particularly in surgical settings. Routine renal monitoring could be considered, especially during hospitalizations and perioperative care.