■大约25%-40%的炎症性肠病(IBD)患者可能有肠外表现,主要涉及肝脏,皮肤,和关节。已经报道了IBD患者的肾脏受累,但在美国的基于人群的研究中没有对其患病率的估计.我们比较了IBD住院患者与胶原血管性疾病住院患者和两种情况均未住院的急性肾损伤(AKI)的发生率。
■回顾性,基于人群的队列研究。
■医疗成本和利用项目-全国住院患者样本数据库。
■需要透析的AKI和AKI。
■回归模型用于比较各组之间AKI的发生。对协变量的平衡组应用治疗加权的逆概率。
■最终样本包括5,735,804次住院,包括57,121名IBD患者,159,930患有胶原血管疾病,5,518,753既没有IBD也没有胶原血管疾病。在13%中观察到AKI,15%,12.2%的IBD住院患者,胶原血管疾病,和普通民众,分别。在调整人口统计时,医院,和临床特征使用治疗加权的逆概率,IBD住院患者被诊断为AKI的几率高于胶原血管疾病患者(比值比[OR],1.32;95%置信区间[CI],1.27-1.38)和一般人群(OR,1.27;95%CI,1.23-1.31),并且被诊断为需要透析的AKI的几率也高于胶原血管疾病(OR,1.59;95%CI,1.31-1.94)或高于一般人群(OR,1.45;95%CI,1.25-1.68)。
■横截面分析,漏报国际疾病分类代码,以及仅与住院相关的分析。
■在IBD住院患者中,AKI的患病率和风险高于胶原血管疾病住院患者和普通人群。在已知诊断为IBD的患者中,应考虑共存的肾脏疾病。
作为肾脏病学家,我们已经评估了许多患有各种形式的肾脏疾病的炎症性肠病患者,炎性和非炎性。基于多种因素,我们一直在想,肠道和肾脏之间是否存在共同的免疫机制,可以解释两个器官的潜在炎症。此外,基于最近对其他自身免疫/炎性疾病的研究,人们对肠道微生物组(肠道中的微生物)的作用及其对免疫系统的影响以及改变的微生物组和免疫系统如何影响肾脏越来越感兴趣。作为第一步,我们想了解某些形式的肾脏疾病在炎症性肠病患者中是否比在普通人群中更普遍,这可能暗示了共同的发病机制。
UNASSIGNED: About 25%-40% of patients with inflammatory bowel disease (IBD) may have extraintestinal manifestations, mainly involving the liver, skin, and joints. Kidney involvement in patients with IBD has been reported, but there are no estimates of its prevalence in population-based studies in the United States. We compared the frequency of acute kidney injury (AKI) among hospitalizations with IBD with that among hospitalizations with collagen vascular diseases and hospitalizations with neither condition.
UNASSIGNED: Retrospective, population-based cohort study.
UNASSIGNED: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database.
UNASSIGNED: AKI and AKI requiring dialysis.
UNASSIGNED: Regression models were used to compare the occurrence of AKI among groups. Inverse probability of treatment weighting was applied to balance groups on covariates.
UNASSIGNED: The final sample comprised 5,735,804 hospitalizations, including 57,121 with IBD, 159,930 with collagen vascular diseases, and 5,518,753 with neither IBD nor collagen vascular diseases. AKI was observed in 13%, 15%, and 12.2% of hospitalizations with IBD, collagen vascular diseases, and the general population, respectively. When adjusting for demographic, hospital, and clinical characteristics using inverse probability of treatment weighting, hospitalizations with IBD had higher odds of being diagnosed with AKI than both those with collagen vascular diseases (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.27-1.38) and the general population (OR, 1.27; 95% CI, 1.23-1.31) and also had higher odds of being diagnosed with AKI requiring dialysis than those with collagen vascular diseases (OR, 1.59; 95% CI, 1.31-1.94) or than the general population (OR, 1.45; 95% CI, 1.25-1.68).
UNASSIGNED: Cross-sectional analysis, underreporting of International Classification of Diseases codes, and analyses relevant to in-hospital stays only.
UNASSIGNED: The prevalence and risk of AKI among hospitalizations with IBD is greater than that of hospitalizations with collagen vascular diseases and the general population. Coexisting kidney disease should be considered among patients with a known diagnosis of IBD.
As a nephrologist, we have evaluated many patients with inflammatory bowel disease with various forms of kidney disease, both inflammatory and noninflammatory. Based on a multitude of factors, we have always wondered if there are shared immune mechanisms between the gut and kidney that could explain the underlying inflammation in both organs. In addition, based on recent studies of other autoimmune/inflammatory diseases, there is growing interest in the role of the gut microbiome (microorganisms that reside in our gut) and its influence on the immune system as well as how both the altered microbiome and immune system affect the kidneys. As a first step, we wanted to understand if some forms of kidney disease are more prevalent in patients with inflammatory bowel disease than in the general population, which possibly suggests a shared pathogenesis.