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Andres Rodriguez, DO, MBA

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Patients with inflammatory bowel disease (IBD), particularly Crohn’s Disease (CD), experience an increased risk of chronic kidney disease (CKD) development, according to new data presented at Digestive Disease Week (DDW) 2024.¹

The analysis of nearly 15,000 patients from a tertiary referral center over 12 years revealed a diagnosis of CKD was approximately 3-times more common among patients with CD than those with ulcerative colitis (UC).

“Patients with CD, especially those with kidney stones and previous intestinal resections, are at increased risk of CKD,” wrote the investigative team, led by Andres Rodriguez, DO, MBA, Emory University School of Medicine. “Indeed, an important proportion of these patients, 11%, needed kidney transplantation.”

A significant global burden, the prevalence of IBD is most impactful in industrialized countries, including northern Europe and North America—the global incidence, however, is increasing and is driven by patients in newly industrialized countries.² Extraintestinal manifestations are observed in up to half of patients diagnosed with IBD.

Previous data have linked the presence of IBD to a range of kidney manifestations.³ However, the impact of both forms of IBD on kidney disease risk differs, with most studies reporting a higher risk of CKD in patients with CD.

Thus, a larger assessment of phenotypes of IBD patients may be critical to determine who is more likely to develop kidney disease so that targeted approaches can improve prevention and treatment outcomes.¹ For this analysis, the investigative team sought to identify IBD-specific risk factors that impacted the increased risk of CKD.

In doing so, Rodriguez and colleagues conducted a case-control population-based study from a tertiary referral center between 2010 and 2022. Inclusion criteria comprised only adults older than 18 —a patient’s IBD diagnosis was confirmed through a chart review of the Crohn’s and Colitis Center gastroenterology note.

Meanwhile, CKD was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria, showing estimated glomerular filtration rate (eGFR) values <60 mL/min/1.73 m2 for ≥3 months apart or with a history of end-stage renal disease requiring a kidney transplant.

A chart review was also performed for the phenotypic classification of patients, including IBD type, history of surgery, results from an endoscopy, and medication use. For each individual, the investigative team examined the Montreal Classification for CD and measured the extent of UC.

For the analysis, Rodriguez and colleagues performed a 1:1 matching of IBD cases with CKD to those without CKD, involving age, gender, and IBD type. Univariate analysis was performed using chi-squared tests and t-tests and a multivariable logistic regression model was fit for the analysis.

Altogether, the analysis identified 15,000 patients with UC or CD across the EPIC system. Confirmation of the correct IBD diagnosis and the presence of CKD left 124 patients for analysis, including 95 with CD and 29 with UC.

Upon analysis, Rodriguez and colleagues observed a CKD diagnosis was approximately three times more common for individuals with CD than UC. Given the limited sample size in UC, the team focused their efforts on the CD to determine the factors associated with CKD.

Across multivariable regression, those with kidney stones exhibited 8 times the likelihood of CKD than those without kidney stones. Individuals with ≥3 surgeries also exhibited 6 times the odds of CKD compared with patients without a history of surgery.

Moreover, a history of previous steroid use was linked with an elevated risk of CKD. On the other hand, those undergoing current immunomodulatory use demonstrated a 78% lower risk of CKD development than those not on immunomodulators.

Rodriguez and colleagues noted current mesalamine use was not associated with a greater likelihood of CKD—location of CD or Montreal phenotype also showed no association with kidney disease.

“It is our hope that these data will alert IBD clinicians to investigate decreased renal function in CD patients and address renal calculi in patients with CD,” Rodriguez and colleagues wrote.

References

1. _{Rodriguez A, Killian R, Quintero MA, Abreu MT. Determining the Factors Associated with Development of Chronic Kidney Disease in a Diverse IBD Population. Poster presented at Digestive Disease Week 2024, May 18 – 21, 2024.}
2. _{Dincer MT, Dincer ZT, Bakkaloglu OK, et al. Renal Manifestations in Inflammatory Bowel Disease: A Cohort Study During the Biologic Era. Med Sci Monit. 2022;28:e936497. Published 2022 Jul 6. doi:10.12659/MSM.936497}
3. _{Liu M, Zhang Y, Ye Z, et al. Inflammatory Bowel Disease With Chronic Kidney Disease and Acute Kidney Injury. Am J Prev Med. 2023;65(6):1103-1112. doi:10.1016/j.amepre.2023.08.008}

With its crushing atmospheric pressure, clouds of sulfuric acid, and searing surface temperature, Venus is an especially challenging place to study. But scientists know that observing its surface can provide key insights into the habitability and evolution of rocky planets like our own. So to get a global perspective of Venus while staying well above its hellish atmosphere, NASA’s VERITAS (Venus Emissivity, Radio science, InSAR, Topography, And Spectroscopy) mission is scheduled to launch within a decade to survey the planet’s surface from orbit, uncovering clues about the nature of its interior.

To lay the groundwork for the mission, members of the international VERITAS science team traveled to Iceland for a two-week campaign in August to use the volcanic island as a Venus stand-in, or analog. Locations on our planet often are used as analogs for other planets, especially to help prepare technologies and techniques intended for more uninviting environments.

“Iceland is a volcanic country that sits atop a hot plume. Venus is a volcanic planet with plentiful geological evidence for active plumes,” said Suzanne Smrekar, senior research scientist at NASA’s Jet Propulsion Laboratory in Southern California and the VERITAS principal investigator. “Its geological similarities make Iceland an excellent place to study Venus on Earth, helping the science team prepare for Venus.”

The VERITAS mission will rely on a state-of-the-art synthetic aperture radar to create 3D global maps and a near-infrared spectrometer to distinguish between the major rock types on Venus’ surface. But to better understand what the spacecraft’s radar will “see” on the planet, the VERITAS science team would need to compare radar observations of Iceland’s terrain from the air with measurements taken on the ground.

From Air to Ground

For the first half of the campaign, the VERITAS science team studied the Askja volcanic deposits and the Holuhraun lava field in the Icelandic Highlands, an active region featuring young rock and recent lava flows. For the second half, they traveled to the volcanically active Fagradalsfjall region on the Reykjanes Peninsula of southwestern Iceland. The barren and rocky landscapes of both resemble Venus’ surface, which is thought to be rejuvenated by active volcanism.

Nineteen scientists from the U.S., Germany, Italy, and Iceland camped and worked long hours to study the surface roughness and other properties of rocks in those regions, collecting lab samples as well. Meanwhile, flights led by the German Aerospace Center (Deutsches Zentrum für Luft- und Raumfahrt, or DLR) collected radar data from above.

Members of the VERITAS science team descend a slope to new rock formed from a recent flow of lava during their Iceland field campaign in early August. The team used the volcanic landscape as a Venus analog to test radar technologies and techniques. Credit: NASA/JPL-Caltech

“The JPL-led science team was working on the ground while our DLR partners flew overhead to gather aerial radar images of the locations we were studying,” said Daniel Nunes, VERITAS deputy project scientist at JPL and Iceland campaign planning lead. “The radar brightness of the surface relates to the properties of that surface, including texture, roughness, and water content. We collected information in the field to ground-truth the radar data that we will use that to inform the science that VERITAS will do at Venus.”

Flying aboard DLR’s Dornier 228-212 aircraft about 20,000 feet (6,000 meters) above the ground, the synthetic aperture radar collected S-band (radio waves with a wavelength of about 12 centimeters, or 4.7 inches) and X-band (about 3 centimeters, or 1.2 inches) data. The shorter wavelength of X-band data – the radio frequency VERITAS will employ – enables the use of a more compact antenna than S-band, which was used by NASA’s Magellan mission to map nearly the entire surface of Venus in the early 1990s.

By observing the surface in both bands in Iceland, the science team will refine computer algorithms that will help VERITAS identify surface changes on Venus that have occurred since Magellan’s mission. Detecting changes over the last 40 years will allow them to identify key regions of geologic activity (such as active volcanoes) on Venus.

Members of the international VERITAS science team prepare for lidar (Light Detection and Ranging) imaging of rocks in Iceland. Lidar measurements of rocky terrain can provide information about the material. Credit: NASA/JPL-Caltech

A key goal for the campaign was to also create a sample library of as many volcanic surface textures in Iceland as possible to better understand Venus’ range of eruption styles. A DLR field team also collected compositional information with a camera that emulates the Venus Emissivity Mapper (VEM) instrument the German Aerospace Center is building for VERITAS. This data will support the spectral library being created at the Planetary Spectroscopy Laboratory in Berlin.

“The different surface characteristics and features seen on Venus relate to volcanic processes, which relate back to the interior of Venus,” said Smrekar. “This data is going to be valuable to VERITAS to help us better understand Venus. It will also help the European Space Agency’s EnVision mission, which will study Venus’ surface with S-band radar, and the community at large that wants to understand radar observations of volcanic planetary surfaces.”

But the value of the two-week Iceland campaign went beyond science, providing a team-building opportunity that will resonate for years to come, said Nunes. “It was a great dynamic,” he added. “We pushed hard and helped each other out. From borrowing gear to driving to the study sites and buying supplies, everyone hustled to make it happen.”

Using a tripod-mounted lidar scanner, the science team created this image that highlighted the ropy texture of new rock formed by a recent lava flow near Iceland’s Litli-Hrútur volcano. This will be used to compare with the campaign’s airborne radar images of the same region. Credits: NASA/JPL-Caltech

More About the Mission

VERITAS and NASA’s Deep Atmosphere Venus Investigation of Noble gases, Chemistry, and Imaging (DAVINCI) mission were selected in 2021 under NASA’s Discovery Program as the agency’s next missions to Venus. VERITAS partners include Lockheed Martin Space, the Italian Space Agency, the DLR, and Centre National d’Études Spatiales in France. The Discovery Program is managed by the Planetary Missions Program Office at NASA’s Marshall Space Flight Center in Huntsville, Alabama, for the Planetary Science Division of NASA’s Science Mission Directorate in Washington.

Astrobiology