Kidney stones and kidney function loss: a cohort study

Abstract

Objective To investigate whether the presence of kidney stones increase the risk of end stage renal disease (ESRD) or other adverse renal outcomes.Design A registry cohort study using validated algorithms based on claims and facility utilisation data. Median follow-up of 11 years.Setting Alberta, Canada, between 1997 and. Participants 3 089 194 adult patients without ESRD at baseline or a history of pyelonephritis. Of these, 1 954 836 had outpatient serum creatinine measurements and were included in analyses of chronic kidney disease and doubling of serum creatinine level.Exposure One or more kidney stones during follow-up.Main outcome measures Incident ESRD, development of stage 3b-5 chronic kidney disease (estimated glomerular filtration rate <45 mL/min/1.73 m 2 ), and sustained doubling of serum creatinine concentration from baseline.Results 23 706 (0.8%) patients had at least one kidney stone, 5333 (0.2%) developed ESRD, 68 525 (4%) developed stage 3b-5 chronic kidney disease, and 6581 (0.3%) experienced sustained doubling of serum creatinine. Overall, one or more stone episodes during follow-up was associated with increased risk of ESRD (adjusted hazard ratio 2.16 (95% CI 1.79 to 2.62)), new stage 3b-5 chronic kidney disease (hazard ratio 1.74 (1.61 to 1.88)), and doubling of serum creatinine (hazard ratio 1.94 (1.56 to 2.43)), all compared with those without kidney stones during follow-up. The excess risk of adverse outcomes associated with at least one episode of stones seemed greater in women than in men, and in people aged <50 years than in those aged ≥50. However, the risks of all three adverse outcomes in those with at least one episode of stones were significantly higher than in those without stones in both sexes and age strata. The absolute increase in the rate of adverse renal outcomes associated with stones was small: the unadjusted rate of ESRD was 2.48 per million person days in people with one or more episodes of stones versus 0.52 per million person days in people without stones.Conclusion Even a single kidney stone episode during follow-up was associated with a significant increase in the likelihood of adverse renal outcomes including ESRD. However, the increases were small in absolute terms.

Annual Incidence of Nephrolithiasis among Children and Adults in South Carolina from 1997 to 2012

“…The rising incidence of nephrolithiasis among younger girls also has important public health implications. Controlling for comorbidities, medications, body mass index, and diet, nephrolithiasis is associated with an increased risk of CKD, cardiovascular disease, and fracture, with the greatest risks observed among younger women (1)(2)(3). Although these associations may not be causal, it is likely that the risks for and burden of these diseases will be greater for patients who develop nephrolithiasis earlier in life because of a longer lifetime over which kidney, heart, and bone diseases may develop.…”

“…Kidney stone disease (nephrolithiasis) is a systemic metabolic disorder associated with increased risks of cardiovascular disease and CKD in adults and fracture in children and adults (1)(2)(3), and it has annual costs .$5.1 billion (4). The estimated prevalence of nephrolithiasis in the United States increased from 5.2% (1988)(1989)(1990)(1991)(1992)(1993)(1994)) to 8.8% (2007)(2008)(2009)(2010) (5,6).…”

Nephrolithiasis as a Risk Factor for CKD

“…As part of the ARIC study visit 3, but not at visit 4, participants were asked whether a doctor had ever told them that they had kidney stones diagnosed by a physician. In addition, inpatient encounters that involved stone disease were identified through ARIC surveillance between 1987 and 2010 by the following International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes on hospital discharge summaries: 592 (calculus of the kidney and ureter), 592.0 (calculus of kidney), 592.1 (calculus of ureter), 592.9 (urinary calculus, unspecified), 594 (calculus of lower urinary tract), and 274.11 (uric acid nephrolithiasis), consistent with codes used in previous cohort studies (22,23). Because these captured only inpatient encounters, we also queried linked data from the US Centers for Medicare and Medicaid Services (CMS) for the same ICD-9-CM codes.…”

“…In crosssectional studies, a history of kidney stones was associated with lower GFR and greater prevalence of CKD (20,21). Two prospective cohort studies from the Mayo Health System and the Alberta Kidney Disease Network demonstrated a higher risk of incident CKD in persons with a history of stone disease (22,23). However, both prospective studies involved universally insured and homogenous populations (96%-99% white) (22,24), thus limiting the generalizability of these findings.…”

The Role of Glomerulosclerosis and Tubular Atrophy as Determining Factor for Reduced Kidney Function in Kidney Stone Disease

“…ESRD unadjusted rate was 2.48 per million people per day in people with one or more episodes of kidney stones compared to 0.52 per million people per day in the people without kidney stones. 8 Kidney stone is a common clinical problem and potentially preventable, therefore, accurate assessment and prompt intervention is required. Histopathologic findings found by post surgical biopsy and microscopic examination may be important to predict residual renal function and long-term outcome.…”