Prevalence and incidence of chronic kidney disease in patients with primary biliary cholangitis.

BACKGROUND

Primary biliary cholangitis (PBC) is a liver disease frequently associated with extrahepatic manifestations. Although a relationship with kidney dysfunction has been reported, data about PBC and chronic kidney disease (CKD) are limited. We assessed the prevalence and incidence of CKD and identify associated risk factors in patients with PBC.

METHODS

This was a multicenter retrospective study involving 1058 consecutive PBC patients. The presence of metabolic comorbidities, including diabetes, hypertension, and dyslipidemia was collected. CKD was defined as eGFR < 60 mL/min/1.73 m2.

RESULTS

Baseline CKD was found in 10% of patients. The number of metabolic factors was associated with progressively lower eGFR levels and higher rates of CKD. Hypertension[OR 2.77 (95%CI 1.60-4.82)], diabetes[OR 2.17(95%CI 1.13-4.18)], ALT[OR 0.92(95%CI 0.88-0.96)], albumin[OR 0.24(95%CI 0.13-0.43)], and platelets[OR 0.996(95%CI 0.992-0.999)] were associated with baseline CKD. CKD was associated with higher mortality (32.1% vs. 7.3%). Seven percent of patients developed CKD. Baseline FIB-4 was associated with CKD incidence: < 1.45: 3% (13/428), 1.45-3.25: 10.2% (31/303), > 3.25: 13.4% (11/82). Baseline eGFR values [OR 0.93(95%CI 0.90-0.96)], cirrhosis [OR 2.31(95%CI 1.09-4.88)], hypertension [OR 2.36 (95%CI 1.14-4.88)], and albumin [OR 0.31(95%CI 0.14-0.72)] were associated with CKD occurrence. Baseline eGFR values [OR 0.90 (95%CI 0.88-0.93)], hypertension at baseline [OR 2.01(95%CI 1.06-3.81)] and progression to cirrhosis [OR 4.50(95%CI 1.96-10.30)] were related to CKD incidence in non-cirrhotic patients. In the absence of comorbidities, maintaining treatment response after follow-up showed 0.9% of de novo CKD (vs. 8%).

CONCLUSIONS

One of every ten PBC patients showed CKD, mainly related to metabolic factors (hypertension and diabetes), and advanced liver disease (albumin and platelets), increasing the risk of mortality. These conditions were also related to the CKD occurrence, even in non-cirrhotic patients.