Risk Factors for Chronic Kidney Disease in Patients With Crohn's Disease

Andres Rodriguez; Maria Alejandra Quintero; Hajar Hazime; Rose Killian; Gloria Michelle Ducasa; Katerina M Faust; Maria T Abreu

doi:10.1093/ibd/izaf039

Risk Factors for Chronic Kidney Disease in Patients With Crohn's Disease

Inflamm Bowel Dis. 2025 Apr 25:izaf039. doi: 10.1093/ibd/izaf039. Online ahead of print.

Authors

Andres Rodriguez¹, Maria Alejandra Quintero², Hajar Hazime², Rose Killian³, Gloria Michelle Ducasa^{1

3}, Katerina M Faust², Maria T Abreu^{2

4}

Affiliations

¹ Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
² UHealth Crohn's & Colitis Center, Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami School of Medicine, Miami, FL, USA.
³ John P. Hussman Institute for Human Genomics, University of Miami, Miami, FL, USA.
⁴ F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

PMID: 40285478
DOI: 10.1093/ibd/izaf039

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Crohn’s disease; chronic kidney disease; inflammatory bowel disease; risk factors.

Plain language summary

Crohn’s disease patients are at higher risk of developing chronic kidney disease. Risk factors include kidney stones, multiple inflammatory bowel diseases–related surgeries, and previous steroid use. We recommend monitoring kidney function and ensuring proper hydration in these patients to prevent kidney-related complications.