The relationship between calcium kidney stones, arterial stiffness and bone density: unraveling the stone-bone-vessel liaison

Chang

Internal Medicine Journal

2018

Section: Discussionsupporting

confidence: 64%

Section: Discussionsupporting

confidence: 62%

Urolithiasis is associated with an increased risk of stroke: a population‐based 5‐year follow‐up study

Chang

Internal Medicine Journal

2018

“…19 Arterial stiffness, which was assessed by carotid-radial pulse wave velocity, carotid-femoral pulse wave velocity and the augmentation index, has been associated with early atherosclerosis. 20 The group noted that such a process also occurs elsewhere, eg in central elastic arteries and peripheral muscular arteries, adding support to the view that this is a systemic phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Calcium Score and Association with Recurrent Nephrolithiasis: The Multi-Ethnic Study of Atherosclerosis

et al. 2016

Purpose Subclinical coronary artery calcification is an established predictor of cardiovascular events. While a history of kidney stones has been linked to subclinical carotid atherosclerosis, to our knowledge no study has examined its relationship with coronary artery calcification. We studied the association between kidney stone history and prevalent coronary artery calcification in MESA (Multi-Ethnic Study of Atherosclerosis). Materials and Methods MESA is a multisite cohort study of participants 45 to 84 years old without known cardiovascular disease at baseline from 2000 to 2002. Computerized tomography was done in 3,282 participants at followup in 2010 to 2012 to determine coronary artery calcification and kidney stone history was assessed by self-report. Coronary artery calcification scores were categorized as none—0, mild—1 to 99, moderate—100 to 399 or severe—400 or greater. Cross-sectional analysis was performed adjusting for demographic and dietary factors related to kidney stones. Results The prevalence of kidney stone disease history was approximately 9%, mean ± SD participant age was 69.5 ± 9.3 years, 39% of participants were Caucasian, 47% were men and 69% had detectable coronary artery calcification (score greater than 0). No difference in the score was seen between single stone formers and nonstone formers. Recurrent kidney stone formation was associated with moderate or severe calcification on multivariable logistic regression vs none or mild calcification (OR 1.80, 95% CI 1.22–2.67). When coronary artery calcification scores were separated into none, mild, moderate and severe calcification, recurrent stone formation was associated with a higher score category on multivariable ordinal logistic regression (OR 1.44 per category, 95% CI 1.04–2.01). Conclusions Recurrent kidney stone formation is associated with subclinical coronary atherosclerosis. This association appeared stronger with coronary artery calcification severity than with coronary artery calcification presence.

Clinical Journal of the American Society of Nephrology

“…Fabris et al went on to confirm the possible relationship between nephrolithiasis and premature atherosclerosis. In their study, a higher pulse wave velocity in KSFs was demonstrated, suggesting an increased stiffness of small arteries, presumably as a consequence of vascular calcification (VC) (6).…”

Section: Introductionmentioning

confidence: 88%

Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers

Shavit

Girfoglio

Vijay

et al. 2015

Self Cite

Background and objectives Recent epidemiologic studies have provided evidence for an association between nephrolithiasis and cardiovascular disease, although the underlying mechanism is still unclear. Vascular calcification (VC) is a strong predictor of cardiovascular morbidity and the hypothesis explored in this study is that VC is more prevalent in calcium kidney stone formers (KSFs). The aims of this study were to determine (1) whether recurrent calcium KSFs have more VC and osteoporosis compared with controls and (2) whether hypercalciuria is related to VC in KSFs.Design, setting, participants, & measurements This is a retrospective, matched case-control study that included KSFs attending an outpatient nephrology clinic of the Royal Free Hospital (London, UK) from 2011 to 2014. Ageand sex-matched non-stone formers were drawn from a list of potential living kidney donors from the same hospital. A total of 111 patients were investigated, of which 57 were KSFs and 54 were healthy controls. Abdominal aortic calcification (AAC) and vertebral bone mineral density (BMD) were assessed using available computed tomography (CT) imaging. The prevalence, severity, and associations of AAC and CT BMD between KSFs and non-stone formers were compared.Results Mean age was 47614 years in KSFs and 47613 in non-stone formers. Men represented 56% and 57% of KSFs and non-stone formers, respectively. The prevalence of AAC was similar in both groups (38% in KSFs versus 35% in controls, P=0.69). However, the AAC severity score (median [25th percentile, 75th percentile]) was significantly higher in KSFs compared with the control group (0 [0, 43] versus 0 [0, 10], P,0.001). In addition, the average CT BMD was significantly lower in KSFs (159653 versus 194 648 Hounsfield units, P,0.001). A multivariate model adjusted for age, sex, high BP, diabetes, smoking status, and eGFR confirmed that KSFs have higher AAC scores and lower CT BMD compared with non-stone formers (P,0.001 for both). Among stone formers, the association between AAC score and hypercalciuria was not statistically significant (P=0.86).Conclusions This study demonstrates that patients with calcium kidney stones suffer from significantly higher degrees of aortic calcification than age-and sex-matched non-stone formers, suggesting that VC may be an underlying mechanism explaining reported associations between nephrolithiasis and cardiovascular disease. Moreover, bone demineralization is more prominent in KSFs. However, more data are needed to confirm the possibility of potentially common underlying mechanisms leading to extraosseous calcium deposition and osteoporosis in KSFs.