Elsevier

Annals of Epidemiology

Volume 14, Issue 3, March 2004, Pages 222-228
Annals of Epidemiology

History of kidney stones as a possible risk factor for chronic kidney disease

https://doi.org/10.1016/S1047-2797(03)00126-1Get rights and content

Abstract

Purpose

The incidence of treated end-stage renal disease has increased progressively in the United States over the past several decades. It has been suggested that kidney stones may be a contributing factor for a small percentage of these patients.

Methods

We conducted a case-control study utilizing 548 hospital cases and 514 age, race and gender-matched community controls. The main outcome measure was diagnosis of chronic kidney disease, assessed by comprehensive chart review. History of kidney stones and other co-variables were obtained during telephone interviews.

Results

This study revealed 16.8% of cases and 6.4% of controls with reported history of kidney stones. The odds ratios (adjusted for confounding variables) for chronic kidney disease (overall), diabetic nephropathy and interstitial nephritis for patients with kidney stones were 1.9 (95% CI: 1.1, 3.3), 2.5 (95% CI: 0.87, 7.0) and 3.4 (95% CI: 1.5, 7.4), respectively. After stratifying by hypertensive status this increased risk persisted only for study participants reporting no history of hypertension.

Conclusion

Kidney stones may play a role in the development of chronic kidney disease. Our study suggests that the prevention of kidney stones may be a means of delaying the onset of chronic kidney disease, however, further studies are needed to make conclusive recommendations.

Introduction

The lifetime prevalence of kidney stones is about 9% in men and nearly 4% in women over the age of thirty in the United States (1). Most people who experience an episode of stones will have at least one recurrence and some will suffer repeated bouts that may increase the likelihood of renal damage from obstruction or surgery (2).

The effect of kidney stones on deterioration of renal function has not been extensively studied in the epidemiologic literature. Stones that result from chronic urinary tract infection with urease-containing bacteria (struvite nephrolithiasis) can cause considerable renal damage and if untreated can lead to end-stage renal disease (ESRD) 3., 4., 5.. But this type of kidney stone accounts for only 15% to 20% of all kidney stones (6). Results from small clinic-based studies of the more common calcium stones are conflicting 7., 8., 9.. Furthermore these studies failed to account for important confounding variables or potential effect modifiers.

We used data from a case-control study to measure associations between self-reported history of kidney stones and newly diagnosed chronic kidney disease. We also compared these associations among hypertensive and non-hypertensive study participants.

Section snippets

Methods

We used data from a case-control study examining several possible risk factors for chronic kidney disease. This study has been described in detail elsewhere (10). Briefly, the study population consisted of hospital patients and community controls, aged 30 to 79 years, residing in North Carolina between 1980 and 1982.

Cases were patients from one of four North Carolina medical centers with newly diagnosed chronic kidney disease, identified by an initial broad review of kidney-related ICD-9

Results

The mean age of our study population was 62 years (range, 30–83 years), 56% were male and 54% were white. As expected, age, race, and sex distributions of cases and controls were almost identical (Table 1). Cases, however, were more likely than controls to have an annual income less than $10,000, have a lower level of education, use analgesic medications daily, and consume cola on a daily basis. In addition, cases were more likely to have a history of kidney stones, gout, pyelonephritis,

Discussion

Our data suggest that kidney stones are associated with an increased risk of chronic kidney disease, especially for interstitial nephritis and diabetic nephropathy. When we stratified by hypertensive status, associations remained strong among persons with no known hypertension, but largely disappeared among those with hypertension.

Chronic kidney disease is frequently seen among patients with kidney stones; an estimated 10% to 15% of these patients eventually progress to chronic kidney failure

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