Sex Differences in Kidney Stone Disease in Chinese Patients with Type 2 Diabetes Mellitus

Abstract

Objectives: To investigate the characteristics of kidney stone disease (KSD) among the Chinese population with type 2 diabetes mellitus (T2DM) and identify sex-specific factors associated with KSD. Methods: A single-center, cross-sectional analysis was performed among Chinese patients with T2DM. KSD was identified by ultrasonography or computed tomography results. Demographic data, physical measurements, laboratory measurements, comorbidities, and related medication data were collected and analyzed. Binary logistic regression was used to explore the associated factors. Results: A total of 7,257 patients with T2DM were included in the study, of which 56.1% were male and 15.0% were diagnosed with KSD. The male-to-female ratio for KSD among T2DM patients was 1.35. Among all the T2DM patients, male gender, HOMA2-IR, uric acid, and renal cysts were independent risk factors for KSD development, whereas serum phosphorus and the use of angiotensin-converting enzyme inhibitors (ACEIs) were independent protective factors for KSD. Among male diabetic patients, triglycerides, HOMA2-IR, renal cysts, and urinary tract infections were all associated with a greater risk of KSD. In contrast, serum phosphorus was associated with a lower risk of KSD. Among female diabetic patients, systolic blood pressure and HOMA2-B were both contributing factors, and ACEIs acted as a protective factor for KSD. Conclusion: Among Chinese patients with T2DM, approximately 1 in 7 patients was affected by KSD, and the prevalence was twice as high as that in the general Chinese population. The factors associated with KSD varied by sex among T2DM patients. Focusing on these factors is beneficial for reducing the risk of KSD and delaying kidney damage in diabetic patients. ease (ESRD) [1]. A review of epidemiological data from seven countries revealed that the prevalence of KSD varied from 1.7% to 14.8% [2]. The health care costs associated with KSD have also increased to more than USD 10 billion in 2006 in the United States [3]. In addition, the disparity in the prevalence of KSD by sex is gradually disappearing, although KSD has historically been twice as common in men than in women. A study in the United States revealed that the male-female ratio of KSD decreased from 1.7 in 1997 to 1.3 in 2002, which might be ascribed to lifestyle changes [4]. A recent study in China reported that the age-and sex-adjusted prevalence of KSD was 5.8% and the male-female ratio was approximately 1.27 (6.5% in men and 5.1% in women) [5]. The reason for the increase in KSD among women is not clearly understood and may partly result from lifestyle and dietary changes and increasing obesity and treatment for stones [3].Diabetes is a common metabolic disease. Type 2 diabetes mellitus (T2DM), which is characterized by insulin resistance (IR), accounts for approximately 90-95% of diabetes cases. The number of people with diabetes worldwide has increased sharply from 108 million in 1980 to 422 million in 2014. The global age-standardized diabetes prevalence has increased from 4....

Gender Differences in Kidney Stone Disease (KSD): Findings from a Systematic Review

“…It has been hypothesised that sex hormones may have a significant role in gender differences for KSD, and 5 studies were identified which investigated this further [22][23][24]26]. Peerapen et al investigated the effects of oestrogen in the kidney [22].…”

“…There is some evidence to support a protective role of ACE-inhibitors on stone formation [25]. Xiao et al performed a cross-sectional analysis in order to investigate this further amongst a population with type 2 diabetes mellitus (DM) [26]. The protection achieved among women was superior to men.…”

Prevalence and trends of urolithiasis among adults

“…A retrospective study conducted between 2014 and 2018 in China reported the overall prevalence of kidney stones among diabetic men and women (17 and 12.6%, respectively), which was twice as high as the general population. Additionally, they reported an annual rise in stone prevalence, which was more notable among diabetic male stone formers [30]. Moreover, using the NHANES from 2013 to 2016, Elia et al [35] reported a significantly higher prevalence of kidney stones among patients with disabilities than patients without disabilities (16.1 vs. 9.2%), and that around one-third of stone formers in the United States were patients with disabilities.…”

“…Table 1 summarizes the findings of the studies that met our inclusion criteria. Twenty-three studies were identified reporting on urolithiasis epidemiology, prevalence, and trends from 11 different countries in the past 2 years [6 ▪▪ ,12,13 ▪ ,14 ▪ ,15,16 ▪▪ ,17,18 ▪ ,19–26,27 ▪ ,28–33].…”

Potassium sodium hydrogen citrate intervention on gut microbiota and clinical features in uric acid stone patients

“…Persistent over-acidification plays a decisive role in this regard. Epidemiologic studies have shown that metabolic syndrome is strongly associated with UAS due to various metabolic and environmental factors promoting insulin resistance and stone formation within urine samples (Abou-Elela 2017 ; Bamberger et al 2021 ; Xiao et al 2020 ). Stone patients who are obese or diabetic tend to have higher proportions of total stones consisting of UAS compared to those who possess normal body mass indices (BMI) or serum glucose levels (Daudon et al 2006a , 2006b ).…”