Proteinuria Is Associated with the Development of Crohn's Disease: A Nationwide Population-Based Study

Seona Park; Hyun Jung Lee; Kyung-Do Han; Hosim Soh; Jung Min Moon; Seung Wook Hong; Eun Ae Kang; Jong Pil Im; Joo Sung Kim

doi:10.3390/jcm10040799

Proteinuria Is Associated with the Development of Crohn's Disease: A Nationwide Population-Based Study

J Clin Med. 2021 Feb 16;10(4):799. doi: 10.3390/jcm10040799.

Authors

Seona Park^{1

2}, Hyun Jung Lee¹, Kyung-Do Han³, Hosim Soh¹, Jung Min Moon¹, Seung Wook Hong⁴, Eun Ae Kang⁵, Jong Pil Im¹, Joo Sung Kim¹

Affiliations

¹ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
² Department of Gastroenterology, Mediplex Sejong Hospital, Incheon 21080, Korea.
³ Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea.
⁴ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
⁵ Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.

Abstract

Background and aims: The impact of proteinuria and its severity on the incidence of inflammatory bowel disease (IBD) has not yet been studied. We aimed to determine the association between proteinuria measured by urine dipstick tests and the development of IBD.

Methods: This nationwide population-based study was conducted using the Korean National Health Insurance Service (NHIS) database. A total of 9,917,400 people aged 20 years or older who had undergone a national health examination conducted by the NHIS in 2009 were followed up until 2017. The study population was classified into four groups-negative, trace, 1+, and ≥ 2+-according to the degree of proteinuria measured by the urine dipstick test. The primary endpoint was newly diagnosed IBD, Crohn's disease (CD), or ulcerative colitis (UC) during the follow-up period.

Results: Compared with the dipstick-negative group, the incidence of CD significantly increased according to the degree of proteinuria (adjusted hazard ratio [aHR] with 95% confidence interval [CI], 1.01 [0.703-1.451], 1.515 [1.058-2.162], and 2.053 [1.301-3.24] in the trace, 1+, and ≥ 2+ dipstick groups, respectively; p for trend 0.007). However, there was no significant difference in the incidence of UC according to the degree of proteinuria (aHR with 95% CI, 1.12 [0.949-1.323], 0.947 [0.764-1.174], and 1.009 [0.741-1.373] in the trace, 1+, and ≥ 2+ dipstick groups, respectively; p for trend 0.722). In the subgroup analysis, dipstick-positive proteinuria independently increased the incidence of CD regardless of the subgroup. However, dipstick-positive proteinuria was associated with the risk of UC in those with diabetes mellitus and not in those without diabetes mellitus (aHR, 1.527 vs. 0.846; interaction p-value 0.004). The risk of CD was increased or decreased according to proteinuria changes but not associated with the risk of UC.

Conclusion: Proteinuria, measured by the dipstick test, is strongly associated with the development of CD.

Keywords: Crohn’s disease; claims data; incidence; proteinuria.

Grants and funding

N/A/Korean Society of Gastroenterology