IBD patients undergoing colectomy at high risk of kidney complications

The rates of acute kidney injury (AKI) and kidney failure appear to rise following colectomy, especially total colectomy or colectomy with a prolonged stroma, in patients with inflammatory bowel disease (IBD), according to a nationwide Swedish cohort study.

A total of 82,051 individuals with biopsy-proven IBD were included in the study. Researchers used Cox proportional hazard models to examine the association between incident colectomy (time-varying exposure) and future risk of AKI and kidney failure (diagnosis of end-stage kidney disease or death due to chronic kidney disease). Additional analyses were conducted to assess the effect of partial versus total colectomy and the presence/duration of a stoma. Covariates included demographics, education level, and selected comorbidities.

Over a median follow-up of 14 years, 16,479 individuals underwent colectomy. There were 2,556 AKI and 1,146 kidney failure events documented.

Colectomy was associated with a more than twofold increase in the risk of both AKI (adjusted hazard ratio [aHR] 2.37, 95 percent confidence interval [CI], 2.17–2.58) and kidney failure (aHR, 1.54, 95 percent CI, 1.34–1.76).

Relative to precolectomy periods, the risk of both kidney outcomes increased following total versus partial colectomy and following colectomy with prolonged stoma versus temporary stoma.

Subgroup analyses showed evidence of the risk of unfavourable renal outcomes being higher in patients with ulcerative colitis.

The findings of the study characterize a high-risk population that may benefit from established protocols for kidney function monitoring/surveillance and referral to nephrologist care.