TOPLINE: 

In a large propensity score-matched cohort, ankylosing spondylitis was significantly associated with increased risks for chronic kidney disease (CKD), acute kidney injury (AKI), initiation of dialysis, glomerular and tubulointerstitial diseases, proteinuria, hematuria, urolithiasis, and kidney and urinary tract neoplasms.

METHODOLOGY: 

• Researchers conducted a retrospective population‑based cohort study using real‑world electronic health records from the TriNetX Global Collaborative Network to evaluate the burden of major nephrologic outcomes in patients with ankylosing spondylitis.
• They included 88,770 patients with ankylosing spondylitis (mean age, 42.8 years; 48.6% women) and 88,770 matched control individuals without ankylosing spondylitis; control individuals were required to have had at least two documented general medical examination encounters.
• The primary outcome was the development of CKD (stages 3-5). Secondary outcomes were AKI, initiation of dialysis , glomerular diseases, tubulointerstitial nephropathies, proteinuria, hematuria, urolithiasis, kidney and urinary tract neoplasms, and kidney transplantation.
• The follow‑up times were 1445.58 days for patients with ankylosing spondylitis and 1471.88 days for matched control individuals.

TAKEAWAY: 

• In patients with ankylosing spondylitis, incidence rates per 1000 patient-years were 4.0 for CKD, 5.2 for initiation of dialysis, 17.4 for AKI, and 33.8 for proteinuria over 10 years.
• Patients with ankylosing spondylitis had more than double the risk for CKD compared with control individuals (hazard ratio [HR], 2.51; 95% CI, 2.21-2.84).
• Ankylosing spondylitis was associated with higher risks for initiation of dialysis (HR, 7.58), AKI (HR, 2.18), kidney transplantation (HR, 2.31), glomerular diseases (HR, 2.06), urolithiasis (HR, 1.66), tubulointerstitial nephropathies (HR, 1.53), proteinuria (HR, 1.14), kidney and urinary tract neoplasms (HR, 1.39), and hematuria (HR, 1.11).
• Men with ankylosing spondylitis had higher risks for most renal outcomes compared with women, except for urinalysis abnormalities such as proteinuria and hematuria.

IN PRACTICE:

“Renal involvement in AS is more prevalent and multifactorial than previously appreciated. These findings highlight the importance of early recognition, regular monitoring, and coordinated care to prevent irreversible kidney injury and to mitigate long-term morbidity in the AS population,” the authors wrote.

SOURCE:

This study was led by Kinga Maria Tyczyńska, Wrocław Medical University, Wrocław, Poland. It was published online on April 13, 2026, in RMD Open.

LIMITATIONS: 

The retrospective design prevented establishing causality and may have resulted in residual confounding due to unmeasured variables. Case ascertainment relied on diagnostic codes, which could have introduced misclassification bias. Additionally, laboratory and histopathologic data were not available for all patients.

DISCLOSURES: 

This study did not report any specific funding. The authors declared no competing interests. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.