Patients undergoing colectomy for inflammatory bowel disease are at a higher risk of developing acute kidney injury and long-term kidney failure, according to a recent observational cohort study.
Researchers utilized data from the nationwide ESPRESSO cohort to examine the association between colectomy and kidney complications, including acute kidney injury (AKI) and chronic kidney failure. The study analyzed 82,051 patients with biopsy-confirmed inflammatory bowel disease (IBD) diagnosed between 1965 and 2017, with follow-up through 2019.
The primary exposure of interest was colectomy, which was treated as a time-varying variable. Colectomy types (partial vs. total) and stoma presence (temporary vs. prolonged) were examined. Outcomes included AKI, defined by acute nephritis or renal failure, and chronic kidney failure, encompassing end-stage kidney disease or death from chronic kidney disease. The study employed Cox proportional hazards models adjusted for age, sex, comorbidities, and education level.
The results, published in Clinical Gastroenterology and Hepatology, reported that colectomy was associated with significantly increased risks 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). Total colectomy carried higher risks for both AKI (aHR, 2.98; 95% CI, 2.70–3.28) and kidney failure (aHR, 1.89; 95% CI, 1.60–2.22) compared to partial colectomy. Patients with prolonged stomas faced the highest risks, with an AKI aHR of 2.26 (95% CI, 1.82–2.81) and kidney failure aHR of 2.36 (95% CI, 1.66–3.36).
Subgroup analyses indicated that patients with ulcerative colitis (UC) had greater risks compared to those with Crohn’s disease (CD). For example, the risk of AKI in UC patients was 2.88 (95% CI, 2.55–3.24) compared to 1.76 (95% CI, 1.50–2.07) in CD patients. A dose-response relationship was observed, with risks increasing from partial to total colectomy.
The study highlighted that risks of kidney complications were highest in the first 6–12 months following colectomy but remained elevated throughout decades of follow-up. A mediation analysis found that AKI accounted for approximately 28% of the increased risk of kidney failure, suggesting additional pathways.
Absolute risk estimates showed that 40 years after colectomy, the cumulative risk of kidney failure was 8%, compared to 4.1% in pre-colectomy patients. The authors emphasized the importance of monitoring kidney function in patients undergoing colectomy, particularly for those with total colectomy or prolonged stomas.
Full disclosures and funding information can be found in the published study.
