The Effect of Disease Severity on 24-Hour Urine Parameters in Kidney Stone Patients With Type 2 Diabetes

Fram, Ethan; Moazami, Saman; Stern, Joshua M.

doi:10.1016/j.urology.2015.10.013

Cited by 15 publications

(10 citation statements)

References 21 publications

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“…Eisner et al[ 3 ] reported that stone forming patients with type II DM excreted significantly greater amount of urinary oxalate and had significantly lower urine pH values than those without DM. Fram et al[ 7 ] also found that kidney stone patients with diabetes had lower urine pH, calcium and phosphate when compared with non-diabetic stone former. All these reports did not include individuals who were not stone formers; therefore, their results might not be applicable to the diabetic patients without kidney stones.…”

Section: Discussionmentioning

confidence: 99%

“…Weinberg et al[ 10 ] reported that HbA1c and a history of insulin use were strongly associated with self-reported stone disease. Fram et al[ 7 ] observed that diabetics with worse glycemic control as measured by HbA1c had changes in their excretion of citrate, creatinine, and total urine volume independent of urine pH. Insulin use was associated with alterations in urinary parameters expected to be protective for stone disease.…”

Section: Discussionmentioning

confidence: 99%

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Difference in 24-Hour Urine Composition between Diabetic and Non-Diabetic Adults without Nephrolithiasis

et al. 2016

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BackgroundDiabetic patients are more likely to develop kidney stones than the general population. The underlying mechanisms for this disparity remain to be elucidated. Little is known about the relationship between urine composition and diabetes mellitus in non-stone-forming individuals. We sought to examine the differences in the 24-hour (24-h) urine composition between diabetic and non-diabetic adults who were not stone formers.MethodsA convenience sample of 538 individuals without a history of nephrolithiasis, gout, hyperparathyroidism, or gastroenteric diseases participated in this study. The 24-h urine profiles of 115 diabetic adults were compared with those of 423 non-diabetic adults. Diabetes was defined by self-reported physician diagnosis or medication use. All participants were non-stone formers confirmed by urinary tract ultrasonography. Participants provided a fasting blood sample and a single 24-h urine collection for stone risk analysis. Student’s t-test was used to compare mean urinary values. Linear regression models were adjusted for age, gender, body mass index, hypertension, fasting serum glucose, serum total cholesterol, estimated creatinine clearance rate and urinary factors.ResultsUnivariable analysis showed that the diabetic participants had significantly higher 24-h urine volumes and lower urine calcium and magnesium excretions than non-diabetic participants (all P < 0.05). After multivariate adjustment, no significant differences in 24-h urine composition were observed between diabetic and non-diabetic participants except for a slightly increased 24-h urine volume in diabetic participants (all P > 0.05). The main limitation of this study is that the convenience samples and self-reported data may have been sources of bias.ConclusionOur data showed that there were no differences in 24-h urine composition between diabetic and non-diabetic adults who are not stone formers. The reason for it might be the improved glycemic control in diabetic individuals in our study. Therefore, a tighter glycemic control might reduce stone formation in diabetic adults.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Difference in 24-Hour Urine Composition between Diabetic and Non-Diabetic Adults without Nephrolithiasis

et al. 2016

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“…In the wider literature, although several studies have investigated the possible role of other various factors on the severity of diabetes, none have provided a severity scoring tool that uses data from various clinical domains as planned in our study that can use the wealth of information routinely collected in electronic healthcare databases. In these studies, approaches used to define diabetes severity included: comparing T2DM severity, before and after obesity surgery; 35 examining the association between diabetes severity and either haematological and immunological changes, 36 levels of urine citrate, 37 a biomarker for adverse outcomes; 38 grip strength; 39 or the use of complementary medicine to manage T2DM. 40 …”

Section: Discussionmentioning

confidence: 99%

Using electronic health records to quantify and stratify the severity of type 2 diabetes in primary care in England: rationale and cohort study design

et al. 2018

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IntroductionThe increasing prevalence of type 2 diabetes mellitus (T2DM) presents a significant burden on affected individuals and healthcare systems internationally. There is, however, no agreed validated measure to infer diabetes severity from electronic health records (EHRs). We aim to quantify T2DM severity and validate it using clinical adverse outcomes.Methods and analysisPrimary care data from the Clinical Practice Research Datalink, linked hospitalisation and mortality records between April 2007 and March 2017 for patients with T2DM in England will be used to develop a clinical algorithm to grade T2DM severity. The EHR-based algorithm will incorporate main risk factors (severity domains) for adverse outcomes to stratify T2DM cohorts by baseline and longitudinal severity scores. Provisionally, T2DM severity domains, identified through a systematic review and expert opinion, are: diabetes duration, glycated haemoglobin, microvascular complications, comorbidities and coprescribed treatments. Severity scores will be developed by two approaches: (1) calculating a count score of severity domains; (2) through hierarchical stratification of complications. Regression models estimates will be used to calculate domains weights. Survival analyses for the association between weighted severity scores and future outcomes—cardiovascular events, hospitalisation (diabetes-related, cardiovascular) and mortality (diabetes-related, cardiovascular, all-cause mortality)—will be performed as statistical validation. The proposed EHR-based approach will quantify the T2DM severity for primary care performance management and inform the methodology for measuring severity of other primary care-managed chronic conditions. We anticipate that the developed algorithm will be a practical tool for practitioners, aid clinical management decision-making, inform stratified medicine, support future clinical trials and contribute to more effective service planning and policy-making.Ethics and disseminationThe study protocol was approved by the Independent Scientific Advisory Committee. Some data were presented at the National Institute for Health Research School for Primary Care Research Showcase, September 2017, Oxford, UK and the Diabetes UK Professional Conference March 2018, London, UK. The study findings will be disseminated in relevant academic conferences and peer-reviewed journals.

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“…Urine volume is influenced by many factors, including disease, drugs, and behaviors that affect what and how much is drunk. Many papers have identified positive correlations between type 2 diabetes and urine volume [ 56 , 57 ]. What is not clear is if type 2 diabetes is always causal for increases in urine volume, if increased urine glucose is always causal for increased urine volume, or if the correlation means that type 2 diabetes or elevated urine glucose increases the risk for increased urine volume.…”

Section: Discussionmentioning

confidence: 99%

Chow fed UC Davis strain female Lepr fatty Zucker rats exhibit mild glucose intolerance, hypertriglyceridemia, and increased urine volume, all reduced by a Brown Norway strain chromosome 1 congenic donor region

et al. 2017

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Our objective is to identify genes that influence the development of any phenotypes of type 2 diabetes (T2D) or kidney disease in obese animals. We use the reproductively isolated UC Davis fatty Zucker strain rat model in which the defective chromosome 4 leptin receptor (LeprfaSte/faSte) results in fatty obesity. We previously produced a congenic strain with the distal half of chromosome 1 from the Brown Norway strain (BN) on a Zucker (ZUC) background (BN.ZUC-D1Rat183–D1Rat90). Previously published studies in males showed that the BN congenic donor region protects from some phenotypes of renal dysfunction and T2D. We now expand our studies to include females and expand phenotyping to gene expression. We performed diabetes and kidney disease phenotyping in chow-fed females of the BN.ZUC-D1Rat183-D1Rat90 congenic strain to determine the specific characteristics of the UC Davis model. Fatty LeprfaSte/faSte animals of both BN and ZUC genotype in the congenic donor region had prediabetic levels of fasting blood glucose and blood glucose 2 hours after a glucose tolerance test. We observed significant congenic strain chromosome 1 genotype effects of the BN donor region in fatty females that resulted in decreased food intake, urine volume, glucose area under the curve during glucose tolerance test, plasma triglyceride levels, and urine glucose excretion per day. In fatty females, there were significant congenic strain BN genotype effects on non-fasted plasma urea nitrogen, triglyceride, and creatinine. Congenic region genotype effects were observed by quantitative PCR of mRNA from the kidney for six genes, all located in the chromosome 1 BN donor region, with potential effects on T2D or kidney function. The results are consistent with the hypothesis that the BN genotype chromosome 1 congenic region influences traits of both type 2 diabetes and kidney function in fatty UC Davis ZUC females and that there are many positional candidate genes.

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The Effect of Disease Severity on 24-Hour Urine Parameters in Kidney Stone Patients With Type 2 Diabetes

Cited by 15 publications

References 21 publications

Difference in 24-Hour Urine Composition between Diabetic and Non-Diabetic Adults without Nephrolithiasis

Difference in 24-Hour Urine Composition between Diabetic and Non-Diabetic Adults without Nephrolithiasis

Using electronic health records to quantify and stratify the severity of type 2 diabetes in primary care in England: rationale and cohort study design

Chow fed UC Davis strain female Lepr fatty Zucker rats exhibit mild glucose intolerance, hypertriglyceridemia, and increased urine volume, all reduced by a Brown Norway strain chromosome 1 congenic donor region

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