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Increased Risk of End-stage Renal Disease in People with Celiac Disease
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Celiac.com 09/19/2011 - Rates of end-stage renal disease are rising globally, and even though doctors often see elevated levels of celiac disease autoantibodies in renal disease, they do not yet fully understand the role of biopsy-verified celiac disease as a risk factor for end-stage renal disease.
To gain a gleaner picture of possible connections, a team of researchers based in Sweden conducted a study of end-stage renal disease in individuals with celiac disease.
The research team included A. Welander, K. G. Prütz, M. Fored, J. F. Ludvigsson. They are affiliated with the Department of Medicine at the Karolinska Institutet of the Karolinska University Hospital in Stockholm, Sweden.
To identify individuals for their population-based prospective cohort study, the team used small-intestinal biopsy reports. They found data on 29,050 individuals with celiac disease (Marsh III) obtained between July 1969 and February 2008 in Sweden's 28 pathology departments.
The team defined end-stage renal disease as the need for renal dialysis or renal transplant in accordance with the international classification of disease and procedure codes in Swedish patient registers.
They used Cox regression to compare the risk of end-stage renal disease in individuals with celiac disease against the risk for age- and sex-matched reference individuals.
They found that, on follow-up, 90 individuals with celiac disease had developed end-stage renal disease, compared with a projected number of 31.
This means that people with celiac disease face an end-stage renal disease risk estimate of 2.87 (95% CI 2.22 to 3.71, p<0.001). Adjusting for diabetes mellitus lowered that risk estimate only slightly, to 2.52 (95% CI 1.92 to 3.31).
When the team excluded people with prior urinary/renal disorders, the risk estimate for end-stage renal disease in people with celiac disease was 2.47 (95% CI 1.80 to 3.40).
However, once the team restricted the outcome measure to end-stage renal confirmed by independent data from the Swedish Renal Registry (SRR), the overall risk estimate increased to 3.20 (95% CI 2.39 to 4.28).
The results of this study show that people with biopsy-verified celiac disease face a higher risk of developing end-stage renal disease.
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