2856 The Epidemiology of Barrett’s Esophagus in Chronic Kidney Disease in the U.S.: A Population-Based Study

Abstract

INTRODUCTION: Background and Aims: Patients with chronic kidney disease (CKD) frequently suffer from gastroesophageal reflux disease (GERD) and have increased risk of various cancers including esophageal cancer. There is limited data in the literature regarding the epidemiology of Barrett’s esophagus (BE) in patients with CKD and if there is any association between both conditions. Using a large database, we sought to describe the epidemiology of BE in CKD. METHODS: Methods: We queried a commercial database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems. We identified a cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT) diagnosis of BE without a diagnosis of CKD from 2014-2019. This was used as the control group. Similarly, we identified a cohort of patients with SNOMED-CT diagnosis of new BE after at least one year of CKD diagnosis. We performed analyses to describe age-, gender-, and race-based distributions and evaluate underlying associations. RESULTS: Of the 36,893,970 individuals in the database (2014-2019), 1,298,830 had the diagnosis of CKD (3.5%) and 179,610 (0.49%) had the diagnosis of BE. Amongst CKD patients, 7,030 (0.54%) individuals had a new diagnosis of BE after at least one year of being diagnosed with CKD. When compared to individuals without a history of CKD, CKD patients were more likely to develop BE [OR: 1.29; 95% CI 1.26-1.33, P < 0.0001]. The prevalence rates of BE in patients with CKD is increasing in the past 5 years as illustrated in Figure 1. Individuals with CKD and BE were more likely to be males vs females, elderly (age >65) vs young adults (age< 65), and African American vs Caucasian. They were also more likely to be smokers, with history of metabolic syndrome, obesity, obstructive sleep apnea, and with diagnosis of GERD when compared to individuals without CKD (Table 1). Limitations: Endoscopic and histological data are not available. This database is at risk of confounding bias. CONCLUSION: Conclusions: In this large database, there is 30% higher prevalence of BE in CKD patients compared to those without CKD. This may be due to increased utilization of health care by CKD patients or an unknown confounding factor or a true association. Given the aforementioned limitations, this association needs to be confirmed in further studies.