Abstract
Purpose
Urolithiasis is a common condition that poses significant morbidity to patients. There are similarities in the development of certain cancers and urinary tract calculi (UTC), however, little is known about their temporal relationship. This study aims to identify if cancer is a risk factor for the development of UTC.
Methods
A population-based retrospective cohort study was conducted for the period 1st January 1990 to 1st May 2016. 124,901 exposed patients identified using clinical codes with newly diagnosed cancer were matched to 476,203 unexposed controls by age, gender, BMI, and general practice. The main outcome measure was the risk of developing UTC described by hazard ratios.
Results
There were 512 incident UTC events in the cancer group compared to 1787 in the unexposed controls. This translated to an adjusted hazard ratio of 1.26 (95% CI 1.14–1.39; p < 0.001). A sub-analysis assessing cancer-specific effects demonstrated increased risks for 10 out of 12 common cancers, most significantly in bladder, colorectal and prostate cancer.
Conclusion
This study demonstrated a 26% increased risk of UTC in cancer patients suggesting wider recognition of this risk amongst clinicians could improve diagnosis and prevention of UTC, as well as encourage further research exploring this association.
Similar content being viewed by others
References
Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD (2017) Burden of urolithiasis: trends in prevalence, treatments, and costs. Eur Urol Focus 3:18–26
Scales CD, Smith AC, Hanley JM, Saigal CS, Urologic Diseases in America Project CS, Project UD in A (2012) Prevalence of kidney stones in the United States. Eur Urol 62:160–5
NHS Digital (2016) Hospital Episode Statistics (HES)—NHS Digital. https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics. Accessed 13 Sep 2018
NHS (2017) 20 painful health conditions—NHS. https://www.nhs.uk/live-well/healthy-body/20-painful-health-conditions/. Accessed 13 Sep 2018
Kumar A, Mohanty NK, Jain M, Prakash S, Arora RP (2010) A prospective randomized comparison between early (< 48 hours of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. J Endourol 24:2059–2066
Fini MA, Elias A, Johnson RJ, Wright RM (2012) Contribution of uric acid to cancer risk, recurrence, and mortality. Clin Transl Med 1:16
Huncharek M, Vassilopoulou-Sellin R (1993) Incidence of hypercalcemia in patients with malignancy referred to a comprehensive cancer center. Cancer 72:956–957
Kanaji N, Watanabe N, Kita N, Bandoh S, Tadokoro A, Ishii T, Dobashi H, Matsunaga T (2014) Paraneoplastic syndromes associated with lung cancer. World J Clin Oncol 5:197
Mirrakhimov AE (2015) Hypercalcemia of malignancy: an update on pathogenesis and management. N Am J Med Sci 7:483–493
Seccareccia D (2010) Cancer-related hypercalcemia. Can Fam Physician 56:244–246, e90-2
Yuan C, Xu X-H, Wang X-L, Xu L, Chen Z, Li Y-Q (2016) Relationship between serum uric acid and metastatic and nonmetastatic rectal cancer patients with undergoing no chemotherapy. Medicine (Baltimore) 95:e5463
Türk C (Chair), Neisius A, Petrik A, Seitz C, Skolarikos A, Guidelines Associates KT: Donaldson JF, Drake T, Grivas N YR (2018) Urolithiasis. https://uroweb.org/guideline/urolithiasis/. Accessed 29 Jan 2019
Ferraro PM, Curhan GC (2017) Serum uric acid and risk of kidney stones. Am J Kidney Dis 70:158–159
Sun L-M, Lin C-L, Chang Y-J, Liang J-A, Liu S-H, Sung F-C, Kao C-H, Liang J-A (2013) Urinary tract stone raises subsequent risk for urinary tract cancer: a population-based cohort study. BJU international https://doi.org/10.1111/bju.12402
Chow WH, Lindblad P, Gridley G, Nyrén O, McLaughlin JK, Linet MS, Pennello GA, Adami HO, Fraumeni JF (1997) Risk of urinary tract cancers following kidney or ureter stones. J Natl Cancer Inst 89:1453–1457
Cheungpasitporn W, Thongprayoon C, O’Corragain OA, Edmonds PJ, Ungprasert P, Kittanamongkolchai W, Erickson SB (2015) The risk of kidney cancer in patients with kidney stones: a systematic review and meta-analysis. QJM 108:205–212
NICE (2015) Renal or ureteric colic—acute. https://cks.nice.org.uk/renal-or-ureteric-colic-acute. Accessed 13 Sep 2018
Office for National Statistics (2014) Cancer registration statistics, England—office for national statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancerregistrationstatisticsengland/2014#main-findings. Accessed 13 Sep 2018
Humphreys BD, Soiffer RJ, Magee CC (2005) Renal failure associated with cancer and its treatment: an update. J Am Soc Nephrol 16:151–161
Blak BT, Thompson M, Dattani H, Bourke A (2011) Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates. Inform Prim Care 19:251–255
IMS Health (2015) IMS Health. http://csdmruk.cegedim.com/. Accessed 6 Aug 2017
Le Jeune I, Gribbin J, West J, Smith C, Cullinan P, Hubbard R (2007) The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK. Respir Med 101:2534–2540
Arana A, Wentworth CE, Fernández-Vidaurre C, Schlienger RG, Conde E, Arellano FM (2010) Incidence of cancer in the general population and in patients with or without atopic dermatitis in the UK. Br J Dermatol 163:1036–1043
Karim ME, Gustafson P, Petkau J, Tremlett H, Long-Term Benefits and Adverse Effects of Beta-Interferon for Multiple Sclerosis (BeAMS) Study Group (2016) Comparison of statistical approaches for dealing with immortal time bias in drug effectiveness studies. Am J Epidemiol 184:325–335
Booth N (1994) What are read codes. Health Libr Rev 11:177–182
Keane MG, Horsfall L, Rait G, Pereira SP (2014) A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer. BMJ Open 4:e005720
NHS Digital (2017) Quality and outcomes framework. NHS Digital, Leeds
Repository CC (2018) ClinicalCodes Repository. https://clinicalcodes.rss.mhs.man.ac.uk/. Accessed 13 Sep 2018
Denburg MR, Leonard MB, Haynes K, Tuchman S, Tasian G, Shults J, Copelovitch L (2014) Risk of fracture in urolithiasis: a population-based cohort study using the health improvement network. Clin J Am Soc Nephrol 9:2133–2140
Turk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2015) EAU guidelines on urolithiasis. http://uroweb.org/. Accessed 19 May
Goldner W (2016) Cancer-related hypercalcemia. J Oncol Pract 12:426–432
Michaelson MD, Cotter SE, Gargollo PC, Zietman AL, Dahl DM, Smith MR (2008) Management of complications of prostate cancer treatment. CA Cancer J Clin 58:196–213
Kamat AM, Hahn NM, Efstathiou JA, Lerner SP, Malmström P-U, Choi W, Guo CC, Lotan Y, Kassouf W (2016) Bladder cancer. Lancet 388:2796–2810
National Institute for Clinical Excellence (NICE) (2017) Gastrointestinal tract (upper) cancers—recognition and referral—NICE CKS. In: NICE Clin. Knowl. Summ. https://cks.nice.org.uk/gastrointestinal-tract-lower-cancers-recognition-and-referral#!scenario. Accessed 29 Jan 2019
Baker ML, Williams RN, Nightingale JMD (2011) Causes and management of a high-output stoma. Color Dis 13:191–197
Ross AC, Taylor CL, Yaktine AL, Del Valle HB Calcium I of M (US) C to RDRI for VD (2011) Dietary reference intakes for calcium and vitamin D. Diet Ref Intakes Calcium Vitam D. https://doi.org/10.17226/13050
Bambach CP, Robertson WG, Peacock M, Hill GL (1981) Effect of intestinal surgery on the risk of urinary stone formation. Gut 22:257–263
Khan A (2018) Prevalence, pathophysiological mechanisms and factors affecting urolithiasis. Int Urol Nephrol 50:799–806
Swann R, McPhail S, Witt J, Shand B, Abel GA, Hiom S, Rashbass J, Lyratzopoulos G, Rubin G (2018) Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit. Br J Gen Pract 68:e63–e72
Foster G, Stocks C, Borofsky MS (2006) Emergency department visits and hospital admissions for kidney stone disease, 2009: statistical brief #139. Agency for Healthcare Research and Quality (US)
Romero V, Akpinar H, Assimos DG (2010) Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 12:e86–e96
Haschke M, Vitins T, Lude S, Todesco L, Novakova K, Herrmann R, Krahenbuhl S (2010) Urinary excretion of carnitine as a marker of proximal tubular damage associated with platin-based antineoplastic drugs. Nephrol Dial Transplant 25:426–433
Funding
None.
Author information
Authors and Affiliations
Contributions
KS and MH conceptualised the study question based on their clinical experience and specialism in the management of urinary tract calculi. KN was primarily involved in developing the study methodology and providing academic supervision for the study. AM completed the literature review and statistical analysis, with support from JSC and BW. AM and JSC revised the manuscript for submission, with support from ME, KS and KN.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to declare.
Ethical approval
There was no legal requirement to obtain patient consent for this study. Although consent was not obtained from patients for data extraction, all data extracted was anonymised and modelled with low risk of identification. Studies analysing data using The Health Improvement Network (THIN) database have ethical approval from the NHS South-East Multicentre Research Ethics Committee, subject to prior independent scientific review. The Scientific Review Committee (IMS Health) approved the study protocol before we performed our analysis (SRC Reference Number: 17THIN007).
Data sharing and accessibility
Full dataset available from the corresponding author at k.nirantharan@bham.ac.uk.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mittal, A., Hassan, M.E., Chandan, J.S. et al. Cancer as a risk factor for urinary tract calculi: a retrospective cohort study using ‘The Health Improvement Network’. Urolithiasis 47, 541–547 (2019). https://doi.org/10.1007/s00240-019-01127-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-019-01127-z