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Original article
Increased risk of end-stage renal disease in individuals with coeliac disease
  1. Adina Welander1,
  2. Karl-Göran Prütz2,
  3. Michael Fored1,
  4. Jonas F Ludvigsson1,3
  1. 1Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  2. 2Department of Nephrology and Transplantation, Skåne University Hospital, Malmö, Sweden
  3. 3Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
  1. Correspondence to Dr Adina Welander, Clinical Epidemiology Unit, Department of Medicine, T2, Karolinska Institutet, 17176 Stockholm, Sweden; adina.welander{at}


Objective The prevalence of end-stage renal disease (ESRD) is increasing worldwide. Although increased levels of coeliac disease (CD) autoantibodies are often seen in renal disease, the importance of biopsy-verified CD for the risk of future ESRD is unclear. The aim of this study was therefore to investigate the risk of future ESRD in individuals with CD.

Methods This was a population-based prospective cohort study. 29 050 individuals with CD (Marsh III) were identified through small-intestinal biopsy reports obtained between July 1969 and February 2008 in Sweden's 28 pathology departments. ESRD was defined as the need for renal dialysis or renal transplant in accordance with the international classification of disease and procedure codes in Swedish patient registers. Using Cox regression, the risk of ESRD in individuals with CD compared with age- and sex-matched reference individuals was estimated.

Results During follow-up, 90 individuals with CD developed ESRD (expected count 31). This corresponded to a HR for ESRD of 2.87 (95% CI 2.22 to 3.71, p<0.001). Adjusting for diabetes mellitus had only a marginal effect on the risk estimate (HR 2.52, 95% CI 1.92 to 3.31). Excluding individuals with any urinary/renal disorder before study entry, the HR for ESRD in CD was 2.47 (95% CI 1.80 to 3.40). When restricting the outcome measure to ESRD confirmed by independent data from the Swedish Renal Registry (SRR), the risk estimate increased to 3.20 (95% CI 2.39 to 4.28).

Conclusion This study indicates that individuals with biopsy-verified CD suffer increased risk of subsequent ESRD.

  • Autoimmune
  • coeliac
  • diabetes mellitus
  • epidemiology
  • coeliac disease
  • paediatric gastroenterology
  • epidemiology
  • Helicobacter pylori
  • acid-related diseases
  • non-ulcer dyspepsia
  • genetic polymorphisms
  • gastric neoplasia
  • inflammation
  • IBD
  • 5-aminosalicylic acid (5-ASA)
  • inflammatory mechanisms
  • radiation enteritis
  • diabetes mellitus
  • autoimmunity

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  • Funding AW was supported by a grant from the Karolinska Institute Board of Postgraduate education (KID). JFL was supported by a grant from the Örebro University Hospital while writing this article. This project was supported by a grant from The Swedish Society of Medicine, the Swedish Research Council, the Sven Jerring Foundation, the Örebro Society of Medicine, the Karolinska Institutet, the Clas Groschinsky Foundation, the Juhlin Foundation, the Majblomman Foundation and the Swedish Celiac Society. KGP is salaried secretary general of the Swedish Renal Registry (SRR).

  • Competing interests None.

  • Ethics approval This study was approved by the Research Ethics Committee of the Karolinska Institutet (dnr 2006/633-31/4).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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