Approximately 1 in 10 patients with primary biliary cholangitis (PBC) live with chronic kidney disease (CKD), according to a study published in the Journal of Gastroenterology. Research led by Jose Manuel Sousa of the Virgen del Rocío University Hospital indicates that metabolic comorbidities—specifically hypertension and type 2 diabetes—significantly increase the risk of developing renal impairment, which is independently linked to higher mortality rates in this population.
Prevalence and Risk Factors for CKD in PBC
The retrospective study, which analyzed 1,058 patients across 13 Spanish hospitals, established that 10.1% of those with PBC also had concurrent CKD. Researchers defined CKD using the CKD Epidemiology Collaboration equation, identifying patients with an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m².
The data revealed clear clinical predictors for baseline kidney damage. The following factors were independently linked to the presence of CKD:
- Arterial Hypertension: Patients with high blood pressure showed an adjusted odds ratio (aOR) of 2.77.
- Type 2 Diabetes: Presence of diabetes carried an aOR of 2.17.
- Albumin Levels: Lower serum albumin levels were a significant indicator (aOR, 0.24).
- Alanine Aminotransferase (ALT): Alanine aminotransferase levels were also identified as a factor (aOR, 0.92).
Impact on Mortality
The study highlights that kidney health serves as a critical prognostic indicator for patients with PBC. Researchers found that patients who presented with baseline CKD faced a significantly higher risk of mortality, with an adjusted hazard ratio of 3.76. This underscores the necessity of viewing renal function not just as a secondary concern, but as a primary factor in managing the long-term health of PBC patients.
Monitoring and Clinical Management
Beyond baseline risk, the researchers identified predictors for developing CKD during the course of follow-up care. These included lower baseline eGFR values, the presence of cirrhosis, arterial hypertension, and low serum albumin levels.
According to the study authors, these findings suggest that clinical care should prioritize:
- Regular Renal Surveillance: Routine monitoring of kidney function is essential for all patients diagnosed with PBC.
- Metabolic Management: Early intervention for hypertension and type 2 diabetes may serve as a protective strategy against kidney injury.
- Liver Disease Tracking: Because cirrhosis is a predictor for future renal decline, close surveillance of liver disease progression remains a key component of preventing secondary kidney complications.
Study Limitations
While the research provides a clear link between PBC and renal decline, the authors noted several limitations. Because CKD was assessed as a binary outcome at the end of the study, the researchers could not calculate an annual incidence rate. Additionally, the study lacked comprehensive data on proteinuria, urinary sediment, and formal nephrology assessments, which limited a deeper analysis of specific renal dysfunction types. The researchers also noted that the small number of patients receiving second-line PBC treatments made it difficult to determine if those specific therapies influenced kidney health.
This study was published on June 22, 2026, and received funding from the Spanish Ministry of Economy, Innovation and Competition, and the Instituto de Salud Carlos III, with co-funding from the European Union. The authors declared no conflicts of interest.