A new thesis from Karolinska Institutet aims to advance our understanding of the bidirectional relationship between inflammatory bowel disease (IBD) and chronic kidney diseases (CKD) through large-scale epidemiological studies utilizing real-world data.
IBD and CKD are chronic conditions with a bidirectional relationship influenced by immune dysregulation, chronic inflammation, and gut-kidney axis interactions. IBD, characterized by persistent gastrointestinal inflammation, is associated with kidney complications such as nephrolithiasis and interstitial nephritis, often stemming from systemic effects or adverse drug reactions. Colectomy, a surgical intervention to remove parts of the colon frequently required in severe IBD cases, can lead to dehydration and electrolyte imbalances, increasing the risk of kidney damage. While biologic therapies have transformed IBD treatment by targeting specific immune pathways to reduce inflammation and induce remission, they carry potential risks, including rare kidney complications like drug-induced interstitial nephritis.
PhD student Yuanhang Yang at the Department of Medical Epidemiology and Biostatistics wanted to explore the intricate interplay between IBD and CKD, as more research is needed to improve patient care and outcomes.
What are the most important results in your thesis?
"Most importantly, our findings emphasize a critical need for vigilant kidney function monitoring in patients with IBD. This is especially crucial for those undergoing colectomy or starting biologic treatments like vedolizumab (an immunosuppressive therapy for both Crohn's disease and ulcerative colitis) to mitigate risks and improve long-term clinical outcomes."
Why did you become interested in this topic?
"I became interested in this topic after recognizing a significant knowledge gap in the interplay between IBD and kidney diseases. With a growing number of patients affected by both conditions, gaining deeper insights is crucial to reduce complications and improve long-term outcomes. My research is among the first to explore the kidney risks associated with colectomy and biologic treatments in IBD, offering novel contributions to the field. The integration of gastroenterology, nephrology, pharmacoepidemiology, and advanced causal inference methods made this research both intellectually challenging and deeply rewarding throughout my PhD journey."
What do you think should be done in future research?
"In clinical practice, standardized protocols for kidney function monitoring in patients with IBD are essential, particularly for those receiving biologic therapy or undergoing surgery, to improve outcomes and reduce complications. Determining the optimal frequency and methods for kidney assessment should be a priority in future health care. Increased kidney risks associated with colectomy and vedolizumab require careful management and further study to refine treatment and perioperative care strategies. Longitudinal research is needed to confirm the bidirectional relationship between IBD and chronic kidney disease and to explore shared mechanisms such as systemic inflammation, microbiome alterations, and immune dysregulation. Collaborative efforts between gastroenterologists and nephrologists will be critical in establishing evidence-based guidelines and enhancing patient care."
Doctoral thesis
" Epidemiological studies on the interplay between inflammatory bowel disease and kidney diseases. "
Yuanhang Yang. Stockholm: Karolinska Institutet (2025), ISBN: 978-91-8017-455-8
