Nephrolithiasis as a Risk Factor for CKD

Abstract

Background and objectives Previous studies demonstrated a higher risk of CKD in persons with a history of kidney stones, but these studies examined mostly white populations and did not evaluate important potential interactions such as race and plasma uric acid.Design, setting, participants, & measurements In 10,678 Atherosclerosis Risk in Communities (ARIC) study participants free of CKD at baseline (ARIC visit 4 in 1996-1998), we assessed the association between a history of nephrolithiasis (a time-varying variable, defined by a combination of self-report and diagnostic codes) and incident CKD (defined by diagnostic codes from linkage to hospitalizations and US Centers for Medicare and Medicaid Services' records).Results At baseline, 856 participants had a history of nephrolithiasis; 322 developed nephrolithiasis during follow-up. Over a mean follow-up of 12 years, there were 1037 incident CKD events. Nephrolithiasis history was associated with a 29% (hazard ratio [HR], 1.29; 95% confidence interval [95% CI], 1.07 to 1.54) higher risk of CKD in demographic-adjusted analyses, but the association was no longer statistically significant after multivariable adjustment (HR, 1.09; 95% CI, 0.90 to 1.32). The multivariable-adjusted association was stronger among participants with plasma uric acid levels #6 mg/dl (HR, 1.34; 95% CI, 1.05 to 1.72) compared with those with levels .6 mg/dl (HR, 0.94; 95% CI, 0.70 to 1.28; P interaction =0.05). There was no interaction of stone disease and race with incident CKD.Conclusions In this community-based cohort, nephrolithiasis was not an independent risk factor for incident CKD overall. However, risk of CKD was unexpectedly elevated in participants with stone disease and lower plasma uric acid levels.

The Risk of Chronic Kidney Disease Associated with Urolithiasis and its Urological Treatments: A Review

“…8 Among 10,678 participants in the Atherosclerosis Risk in Communities study, the adjusted risk of incident CKD was only 10% higher for those with a history of kidney stones and not statistically significant; however, the risk was significantly higher among those with plasma uric acid levels ≤6 mg/dL (HR, 1.34; 95% CI 1.05, 1.72). 9 The use of diagnostic codes to define CKD could partially explain the overall null findings of this study.…”

DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease

“…58 Several ARIC study publications have used this composite outcome. 59-61 In a sensitivity analysis of kidney disease based only on eGFR, the association between DASH diet and kidney disease was slightly stronger than that with the composite outcome. The lack of data on albuminuria, which is strongly associated with kidney function decline, is a limitation.…”

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

“…191 Among 10 678 patients in the Atherosclerosis Risk in Communities study, nephrolithiasis history was associated with a 29% (HR, 1.07 1.29 1.54 ) higher risk of CKD in demographic-adjusted analyses, but the association was no longer statistically significant after multivariable adjustment (HR, 0.90 1.09 1.32 ;). 192 To inform this guideline, CKD-PC analyzed multiple cohorts (see chapter 1). 7 They found the association between a prior history of kidney stones and ESKD was not significant in the meta-analysis; for this reason a history of kidney stones does not appear as a characteristic in the online tool to predict the 15-year and lifetime chance of kidney failure in the absence of donation.…”