The Influence of End-Stage Renal Disease on Ulcerative Colitis Hospitalizations: A Comparative Analysis in the United States

Introduction: Patients with inflammatory bowel disease (IBD) can have varied extra intestinal manifestations, with renal conditions described in 4%-23% of patients with IBD. IBD has also been associated with an increased risk of chronic kidney disease (CKD). Data on patients with ulcerative colitis (UC) and end stage renal disease (ESRD), where patients need dialysis, remains spars. In this study, we aimed to identify hospitalization characteristics and outcomes of ESRD in UC hospitalizations in the US. Methods: We used the National Inpatient Sample to identify all adult hospitalizations for UC in the US from 2016-2020. The study population was sub-grouped based on the presence or absence of ESRD. Hospitalization characteristics and outcomes were compared. P-values < 0.05 were statistically significant. Results: Between 2016-2020, there were 410,950 hospitalizations for UC, of which 2,140 had ESRD (0.52%). 3/4th of the hospitalizations were at urban teaching centers. Hospitalizations with ESRD had higher mean age (61.9 vs 51.18 years, P< 0.001). Racial differences were noted as this subgroup had higher proportion of Blacks (33.3% vs 9.6%, P< 0.001) and lower proportion of Whites (44.9% vs 75.8%, P< 0.001). They had higher Medicare utilization (75.2 % vs 34.9%, P< 0.001), longer mean length of stay [LOS] (5.5 vs 4.6, P< 0.001) and higher mean total healthcare charge ($73,180 vs $49,614, P< 0.001). UC hospitalizations with ESRD had higher rate of comorbidities, including hypertension, COPD, diabetes mellitus and coronary artery disease, and higher mortality (2.3% vs 0.3%, P< 0.001). Furthermore, this sub-group had significantly higher incidence of blood transfusion and malnutrition. There was no significant difference in rates of sepsis, pulmonary embolism, ano-rectal abscess, rectal hemorrhage and total colectomy between the UC hospitalizations with and without ESRD. After adjusting for age, sex, payer, race, hospital bed size, teaching status, above mentioned comorbidities, and prolonged LOS, UC hospitalizations with ESRD had higher mortality, than those without ESRD (OR 4.52, 95% CI 2.23-9.17) (Figure 1, Table 1). Conclusion: UC hospitalizations with ESRD had higher co-morbidity, mortality, LOS and THC than those without ESRD. This group tended to be older, with increased proportion of Blacks. Though rates of colectomy were similar in the 2 groups, UC hospitalizations with ESRD had higher odds of mortality. More studies are needed to better and effective care for patients with UC and ESRD.Figure 1.: Comparative analysis of racial distribution for ulcerative colitis hospitalizations, with and without end-stage renal disease, in the United States from 2016-2020. Table 1. - Comparative analysis of hospitalization characteristics and clinical outcomes between ulcerative colitis hospitalizations, with and without end-stage renal disease, in the United States between 2016-2020 Variable Ulcerative colitis hospitalizations with ESRD Ulcerative colitis hospitalizations without ESRD P-value Total hospitalizations 2,140 410,950 Mean Age (years) 61.9 51.2 < 0.001 Female 50.2% 55% 0.052 Race Black 33.2% 9.6% < 0.001 White 44.8% 75.8% < 0.001 Medicare 75.2% 34.9% < 0.001 Urban teaching hospital 74.8% 74.4% 0.08 Mean length of stay (days) 5.5 4.6 < 0.001 Mean total hospital charges (USD) 73,180 49,615 < 0.001 Hypertension 88.55% 39.1% < 0.001 COPD 18.22% 7.9% < 0.001 Diabetes mellitus 56.07% 14.9% < 0.001 Coronary artery disease 36.68% 11.71% < 0.001 Ano-rectal abscess 0.23% 0.55% 0.792 Rectal hemorrhage 1.64% 1.04% 0.618 Intestinal obstruction 1.17% 1.8% 0.632 Sepsis 5.37% 5.65% 0.157 Shock 4.44% 2.56% 0.01 PE 3.04% 2.59% 0.932 Blood transfusion 11.45% 5.88% < 0.001 Malnutrition 6.78% 5.1% 0.006 Total colectomy 0.7% 3.21% 0.317