Inflammatory Bowel Disease Is Associated With an Increased Risk of End‐Stage Renal Disease: A Population‐Based Cohort Study

BACKGROUND: Inflammatory bowel disease (IBD) is associated with renal complications, but population-based data on end-stage renal disease (ESRD) are limited. AIM: To evaluate the incidence of ESRD and renal transplantation in IBD compared with the general population and to identify predictive factors associated with ESRD in the IBD population. METHODS: This was a retrospective population-based cohort study using the University of Manitoba IBD Epidemiology Database linked to administrative healthcare data from 1984 to 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. RESULTS: IBD patients had a 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. CONCLUSIONS: Persons with IBD have an increased risk of ESRD by nearly 50%, with CD showing a greater risk than UC. Bowel surgery, allopurinol use and oral steroid therapy are important predictors, emphasising the necessity of careful renal monitoring in IBD patients.