Impact of statins on nephrolithiasis in hyperlipidemic patients: a 10-year review of an equal access health care system

Sur, Roger L.; Masterson, James H.; Palazzi, Kerrin; L’Esperance, James O.; Auge, Brian K.; Chang, David C.; Stoller, Marshall L.

doi:10.5414/cn107775

Cited by 38 publications

(32 citation statements)

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“…This animal model study was supported by a clinical perspective, as Sur et al . showed that statin medications had a protective effect against stone formation after adjusting for age, sex and comorbidities . The results of the present analysis also provide some support for the use of antilipidemic drugs for urolithiasis, but we cannot yet suggest the use of statins as a part of preventive strategies.…”

Section: Discussionmentioning

confidence: 99%

Association between blood lipid profile and urolithiasis: A systematic review and meta‐analysis of observational studies

Beşiroğlu

Özbek

2018

Int J of Urology

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The objective of this study was to pool individual studies regarding the association of blood lipid profiles with urolithiasis to carry out a systematic review and meta-analysis. We searched MEDLINE, PubMed, Embase and Cochrane Library to identify the relevant studies up to November 2017. Studies that met all inclusion criteria were chosen, and a pooled analysis of the odds ratio between urolithiasis and dyslipidemia traits was calculated. A total of 11 observational studies (seven cross-sectional, three cohort, one case-control) with a total of 282 479 participants were examined. The overall pooled analysis of eight studies showed that high triglyceride was associated with increased estimated risk of urolithiasis (odds ratio 1.287, 95% CI 1.073-1.544; P = 0.007). Estimates of the total effect size were consistent in the sensitivity analysis. No evidence of publication bias was detected. The overall pooled analysis of nine studies showed low high-density lipoprotein was weakly associated with increased estimated risk of urolithiasis (odds ratio 1.171, 95% CI 1.010-1.358; P = 0.032). The sensitivity analysis showed conflicting results. No evidence of publication bias was detected. Three studies on the association between any dyslipidemia traits and urolithiasis showed a significant association (odds ratio 1.309, 95% CI 1.202-1.425; P < 0.001). The present meta-analysis showed that patients with higher triglyceride and lower high-density lipoprotein had an increased estimated risk of urolithiasis. A triglyceride-urolithiasis association was found to be more coherent and consistent compared with the high-density lipoprotein-urolithiasis association. Although somewhat contradictory results have been found, the meta-analysis is encouraging for evaluating urolithiasis as a systemic disorder. Further well-designed prospective randomized controlled or cohort studies are necessary to better elucidate the causal association of dyslipidemia and urolithiasis.

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Section: Discussionmentioning

confidence: 99%

Association between blood lipid profile and urolithiasis: A systematic review and meta‐analysis of observational studies

Beşiroğlu

Özbek

2018

Int J of Urology

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“…Although statin medications pharmacologically lower LDL levels, they also increase HDL through unclear mechanisms [19]. And in fact, statins have been demonstrated to decrease the risk of nephrolithiasis [20]. Age divided into two categories above and below 35 years trended towards significance in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Dyslipidemia is associated with an increased risk of nephrolithiasis

et al. 2014

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The pathophysiology of nephrolithiasis is multifactorial. Obesity, diabetes mellitus and hypertension are implicated in its formation. Dyslipidemia (DLD) recently has received attention as well. Congruent with a vascular etiology in stone formation, DLD theoretically would predispose patients to nephrolithiasis. We investigated a possible association of DLD with nephrolithiasis. A random cohort of 60,000 patients was established by collecting the first 5,000 patient charts per month in the year 2000. After excluding pediatric patients, a retrospective study was performed by reviewing age, sex, comorbidities, and last patient follow-up. Median lipid laboratory levels also were reviewed. Descriptive statistics were performed as well as Cox proportional-hazards regression analysis, and univariate and multivariate analyses. 52,184 (22,717 women/29,467 men) patient charts were reviewed. The average age was 31.0 ± 15.2 years. On univariate analysis, DLD was associated with nephrolithiasis with a hazard ratio (HR) of 2.2 [Confidence Interval (CI), 1.9–2.5; p < 0.001] and on multivariate analysis HR = 1.2 (1.0–1.5; p = 0.033). Low-density lipoprotein and triglycerides had no association with stone disease. Patients with high-density lipoprotein (HDL) values <45 for men and <60 for women had an HR of 1.4 (1.1–1.7, 95% CI, p = 0.003) on univariate analysis and on multivariate analysis; HR = 1.27 (1.03–1.56; p = 0.024) for nephrolithiasis. DLD was associated with an increased risk of stone disease though the only specific lipid panel associated with lower nephrolithiasis was HDL. Clinicians should consider obtaining lipid levels with the intent that treatment could potentially not only mitigate atherosclerotic disease but also decrease nephrolithiasis risk.

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“…We also identified UTIs during the period in which antibiotic exposure was assessed. Because of their association with nephrolithiasis, outpatient prescriptions for proton-pump inhibitors (PPIs), 16 statins, 17 thiazide diuretics, and loop diuretics were identified. We considered individuals exposed to these drugs if they had a prescription of any duration and dose during the period in which antibiotic exposure was assessed.…”

Section: Significance Statementmentioning

confidence: 99%

Oral Antibiotic Exposure and Kidney Stone Disease

Tasian¹,

Jemielita

Goldfarb

et al. 2018

JASN

120

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Although intestinal and urinary microbiome perturbations are associated with nephrolithiasis, whether antibiotics are a risk factor for this condition remains unknown. We determined the association between 12 classes of oral antibiotics and nephrolithiasis in a population-based, case-control study nested within 641 general practices providing electronic health record data for >13 million children and adults from 1994 to 2015 in the United Kingdom. We used incidence density sampling to match 25,981 patients with nephrolithiasis to 259,797 controls by age, sex, and practice at date of diagnosis (index date). Conditional logistic regression models were adjusted for the rate of health care encounters, comorbidities, urinary tract infections, and use of thiazide and loop diuretics, proton-pump inhibitors, and statins. Exposure to any of five different antibiotic classes 3-12 months before index date was associated with nephrolithiasis. The adjusted odds ratio (95% confidence interval) was 2.33 (2.19 to 2.48) for sulfas, 1.88 (1.75 to 2.01) for cephalosporins, 1.67 (1.54 to 1.81) for fluoroquinolones, 1.70 (1.55 to 1.88) for nitrofurantoin/methenamine, and 1.27 (1.18 to 1.36) for broad-spectrum penicillins. In exploratory analyses, the magnitude of associations was greatest for exposure at younger ages (<0.001) and 3-6 months before index date (<0.001), with all but broad-spectrum penicillins remaining statistically significant 3-5 years from exposure. Oral antibiotics associated with increased odds of nephrolithiasis, with the greatest odds for recent exposure and exposure at younger age. These results have implications for disease pathogenesis and the rising incidence of nephrolithiasis, particularly among children.

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Impact of statins on nephrolithiasis in hyperlipidemic patients: a 10-year review of an equal access health care system

Abstract: Statin medications are associated with reduced risk of urinary stones. This is the first study to demonstrate the impact of statins on nephrolithiasis. Further prospective studies are necessary to validate these findings that treatment of hyperlipidemia reduces stone risk formation.

Cited by 38 publications

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Association between blood lipid profile and urolithiasis: A systematic review and meta‐analysis of observational studies

Association between blood lipid profile and urolithiasis: A systematic review and meta‐analysis of observational studies

Dyslipidemia is associated with an increased risk of nephrolithiasis

Oral Antibiotic Exposure and Kidney Stone Disease

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