炎症性肠病合并慢性肾脏病与急性肾损伤。
Inflammatory Bowel Disease With Chronic Kidney Disease and Acute Kidney Injury.
机构信息
Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; National Clinical Research Center for Kidney Disease, Guangzhou, China; State Key Laboratory of Organ Failure Research, Guangzhou, China; Guangdong Provincial Institute of Nephrology, Guangzhou, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; National Clinical Research Center for Kidney Disease, Guangzhou, China; State Key Laboratory of Organ Failure Research, Guangzhou, China; Guangdong Provincial Institute of Nephrology, Guangzhou, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
出版信息
Am J Prev Med. 2023 Dec;65(6):1103-1112. doi: 10.1016/j.amepre.2023.08.008. Epub 2023 Aug 10.
INTRODUCTION
It remains unclear whether inflammatory bowel disease is associated with long-term risk of chronic kidney disease (CKD) and acute kidney injury (AKI) in the general population.
METHODS
A total of 417,302 participants, including 2,940 patients with ulcerative colitis and 1,261 patients with Crohn's disease, without previous CKD and AKI at baseline (2006-2010) from the UK Biobank were included. The study outcomes included incident CKD and AKI, ascertained by self-report data and data linkage with primary care, hospital admissions, and death registry records. Analysis was conducted in 2022.
RESULTS
During a median follow-up of 12.5 years, 13,564 and 14,331 participants developed CKD and AKI, respectively. Compared with the hazard ratio for non-inflammatory bowel diseases, the hazard ratios for CKD and AKI related to inflammatory bowel diseases were 1.57 (95% CI=1.37, 1.79) and 1.96 (95% CI=1.74, 2.20) after adjustments for age, sex, and race and were 1.32 (95% CI=1.15, 1.51) and 1.70 (95% CI=1.51, 1.91) after further adjustments for biological, behavioral, and socioeconomic factors in addition to mental health and self-rated health. Similar results were found for patients with Crohn's disease (adjusted hazard ratio=1.38 (95% CI=1.09, 1.75) for CKD and 1.62 [95% CI=1.30, 2.02] for AKI) and those with ulcerative colitis (adjusted hazard ratio=1.29 (95% CI=1.09, 1.51) for CKD and 1.71 [95% CI=1.49, 1.97] for AKI) in the fully adjusted models. Genetic risks of kidney diseases did not significantly affect the association of inflammatory bowel disease with incident CKD and AKI (both p-interactions>0.05). The association between inflammatory bowel disease and the risk of incident CKD (p-interaction=0.010) and AKI (p-interaction<0.001) were stronger in younger participants than in older participants.
CONCLUSIONS
Inflammatory bowel disease was associated with higher risks for CKD and AKI, independent of genetic risks of kidney diseases.
简介
目前尚不清楚炎症性肠病是否与普通人群的慢性肾脏病（CKD）和急性肾损伤（AKI）的长期风险相关。
方法
共纳入来自英国生物银行的 417302 名参与者，其中包括 2940 例溃疡性结肠炎患者和 1261 例克罗恩病患者，这些患者在基线时（2006-2010 年）均无先前的 CKD 和 AKI。研究结局包括通过自我报告数据和与初级保健、住院和死亡登记记录的数据链接确定的新发 CKD 和 AKI。分析于 2022 年进行。
结果
在中位随访 12.5 年期间，分别有 13564 名和 14331 名参与者发生 CKD 和 AKI。与非炎症性肠病的风险比相比，炎症性肠病相关的 CKD 和 AKI 的风险比分别为 1.57（95%CI=1.37，1.79）和 1.96（95%CI=1.74，2.20），在调整年龄、性别和种族后为 1.32（95%CI=1.15，1.51）和 1.70（95%CI=1.51，1.91），在进一步调整生物学、行为和社会经济因素以及心理健康和自我评估健康后为 1.32（95%CI=1.15，1.51）和 1.70（95%CI=1.51，1.91）。在克罗恩病患者（调整后的风险比=1.38（95%CI=1.09，1.75），AKI=1.62[95%CI=1.30，2.02]）和溃疡性结肠炎患者（调整后的风险比=1.29（95%CI=1.09，1.51），AKI=1.71[95%CI=1.49，1.97]）中也发现了类似的结果。肾脏疾病的遗传风险并不显著影响炎症性肠病与新发 CKD 和 AKI 之间的关联（均 p 交互作用>0.05）。炎症性肠病与新发 CKD（p 交互作用=0.010）和 AKI（p 交互作用<0.001）风险之间的关联在年轻参与者中强于在老年参与者中。
结论
炎症性肠病与 CKD 和 AKI 的风险增加相关，独立于肾脏疾病的遗传风险。
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