Frailty predicts a higher risk of incident urolithiasis in 525 368 patients with diabetes mellitus: a population-based study

Abstract

ObjectivePatients with diabetes have an increased risk for urolithiasis, but the associated risk factors remain an active area of research. We investigated whether frailty influenced the probability of patients with diabetes developing urolithiasis.Research design and methodsUsing data from the Longitudinal Cohort of Diabetic Patients from 2004 to 2010, we identified those without and with frailty based on a validated, modified FRAIL scale. Patients were followed until they developed urolithiasis, and we used Kaplan-Meier and Cox proportional hazard regression analyses to examine the relationship between frailty, its severity, and the risk of urolithiasis, accounting for demographic profiles, comorbidities, frailty status changes over follow-up, and medications, with risk competition by mortality.ResultsAmong 525 368 patients with diabetes, 64.4% were not frail, while 28.5%, 6.6%, and 0.6% had 1, 2, and ≥3 FRAIL items at baseline. After 4.2 years of follow-up, 13.4% experienced incident urolithiasis. Cox proportional hazard regression analysis showed that patients with diabetes having at least one FRAIL criterion exhibited a significantly higher risk for urolithiasis compared with non-frail patients (for 1, 2, and ≥3 items, hazard ratio (HR)s: 1.04, 1.23, and 1.46; 95% confidence intervals (CIs) 0.99 to 1.09, 1.12 to 1.35, and 1.12 to 1.91, respectively). This increase in urolithiasis risk remained significant if we restricted analyses to renal stones or recurrent urolithiasis as the study outcomes.ConclusionsFrailty may pose a risk for incident urolithiasis in patients with diabetes. Treating frailty may potentially reduce their risk for urolithiasis.

Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease

“…Sarcopenia frequently accompanies frailty and correlates with an increased likelihood of urine retention, catheterization and impaired mobility, all of which contribute to the risk of UTI among vulnerable population such as in-patients [ 45 ]. Finally, a recent study discovered that having frailty placed an individual at a higher risk of developing urolithiasis through multiple mechanisms including hypercalciuria and immobilization [ 27 ], and UTI can be a potential complication resulting from structural damages caused by urolithiasis. We thus provided a putative summary of the potential mechanisms responsible for the observed relationship between frailty and the UTI risk based on the existing literature in Fig.…”

“…Patients were deemed positive for individual item if they had any of the diagnostic code combinations during ≥ 2 out-patient clinics or ≥ 1 hospitalization episode within the preceding years of the index date. The utilization of this approach has been found to be quite informative in identifying patients with more physically prominent frailty, as patients with frailty based on this modified FRAIL scale have a significantly higher risk of delirium, adverse outcomes, and higher healthcare utilization than those without [ 14 , 15 , 27 , 28 ]. Participants were categorized based on whether they did not have, or had 1, 2, and ≥ 3 FRAIL items, with regard to the risk of developing the outcomes of this study.…”

Chronic Lower Extremity Ischemia and Its Association with the Frailty Syndrome in Patients with Diabetes

“…In the population-based study conducted by Chao et al involving 525,368 patients with diabetes, 64.4% were not frail, while 28.5%, 6.6%, and 0.6% had one, two, and three or more features of Frailty, respectively. It has also been observed that factors such as age, feminine gender, smoking and alcoholism were significantly associated with increased susceptibility to the development of Frailty [ 20 ].…”

“…For example, it has been proven that it increases risk of progression of diabetic kidney disease to end-stage renal disease [ 21 ]. Patients with diabetes and the features of Frailty are more likely to develop urolithiasis [ 20 ]. According to the results of the meta-analysis conducted by Ida et al in patients living with diabetes there is a relationship between the incidence of Frailty and the mortality and risk of hospitalization [ 22 ].…”

The Role of Metabolic Disorders in the Formation of Urolithiasis in Patients With Type 2 Diabetes Mellitus

“…10-15 years ago, it was 0.5-1 %, but now various authors give prevalence figures from 6 to 10 % [5,6]. There are contradictory opinions about the mechanisms of stone formation in patients with diabetes.…”