Rodriguez Andres, Quintero Maria Alejandra, Hazime Hajar, Killian Rose, Ducasa Gloria Michelle, Faust Katerina M, Abreu Maria T
Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
UHealth Crohn's & Colitis Center, Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami School of Medicine, Miami, FL, USA.
Inflamm Bowel Dis. 2025 Oct 1;31(10):2693-2703. doi: 10.1093/ibd/izaf039.
Patients with inflammatory bowel diseases (IBD), including Crohn's disease (CD), are at risk of complications, including kidney disease. It is important to identify IBD patients at higher risk of chronic kidney disease (CKD) to improve prevention and treatment. Here, we investigated the clinical and metabolomic characteristics of CD patients who develop CKD.
We identified adult CD patients with (CD + CKD, n = 87) and selected CD patients without CKD (CD controls) matched by age, race, and gender. We collected data on demographic characteristics (age, smoking status, ethnicity, gender), IBD characteristics (diagnosis, Montreal classification, medication use, IBD-related surgeries, perianal disease), and kidney-related factors (primary sclerosing cholangitis, end-stage renal disease, hypertension, diabetes, organ transplantation, and nephrolithiasis). Univariate and multivariate analyses were conducted and odds ratios were calculated to identify risk factors for CKD. Serum samples were collected for untargeted metabolomic analysis.
Chronic kidney disease was far more common in CD patients than UC patients. Crohn's disease patients with kidney stones had a 10-fold higher risk of developing CKD than those without kidney stones. Crohn's disease patients with more than 2 IBD-related surgeries had a 7.3-fold higher risk of developing CKD than those who had not undergone surgery. There was no relationship between the number of biologics used or mesalamine use and the risk of CKD. The serum of CD + CKD patients had elevated levels of pro-inflammatory metabolites and those linked to kidney injury.
We recommend regular kidney function monitoring and ensuring proper hydration to prevent or manage potential kidney-related complications in CD patients. Patients with resections and kidney stones are particularly vulnerable.
炎症性肠病（IBD）患者，包括克罗恩病（CD）患者，存在包括肾脏疾病在内的并发症风险。识别慢性肾脏病（CKD）风险较高的IBD患者对于改善预防和治疗至关重要。在此，我们研究了发生CKD的CD患者的临床和代谢组学特征。
我们确定了患有CKD的成年CD患者（CD+CKD，n = 87），并选择了年龄、种族和性别相匹配的无CKD的CD患者（CD对照组）。我们收集了人口统计学特征（年龄、吸烟状况、种族、性别）、IBD特征（诊断、蒙特利尔分类、用药情况、IBD相关手术、肛周疾病）以及肾脏相关因素（原发性硬化性胆管炎、终末期肾病、高血压、糖尿病、器官移植和肾结石）的数据。进行单因素和多因素分析并计算优势比以确定CKD的危险因素。收集血清样本进行非靶向代谢组学分析。
CKD在CD患者中比在溃疡性结肠炎（UC）患者中更为常见。患有肾结石的克罗恩病患者发生CKD的风险比没有肾结石的患者高10倍。接受过2次以上IBD相关手术的克罗恩病患者发生CKD的风险比未接受手术的患者高7.3倍。使用生物制剂的数量或美沙拉嗪的使用与CKD风险之间没有关系。CD+CKD患者的血清中促炎代谢物和与肾损伤相关的代谢物水平升高。
我们建议定期监测肾功能并确保充足的水合作用，以预防或管理CD患者潜在的肾脏相关并发症。接受过手术和患有肾结石的患者尤其易受影响。
