Shoag Jonathan, Halpern Joshua, Goldfarb David S, Eisner Brian H
Department of Urology, Weill Cornell Medical College, New York, New York.
New York Harbor VA Healthcare System, New York, New York; NYU School of Medicine, New York, New York.
J Urol. 2014 Nov;192(5):1440-5. doi: 10.1016/j.juro.2014.05.117. Epub 2014 Jun 11.
We examine kidney stone disease as a potential risk factor for chronic kidney disease, end stage kidney disease and treatment with dialysis.
The NHANES (National Health and Nutrition Examination Survey) 2007-2010 database was interrogated for patients with a history of kidney stones. Demographics and comorbid conditions including age, gender, body mass index, diabetes, hemoglobin A1c, hypertension, gout and smoking were also assessed. Multivariate analysis adjusting for patient demographics and comorbidities was performed to assess differences in the prevalence of chronic kidney disease and treatment with dialysis between the 2 groups. History of nephrolithiasis was assessed with the question, "Have you ever had kidney stones?" Chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 ml/minute/1.73 m(2) and/or a urinary albumin-to-creatinine ratio greater than 30 mg/gm. Statistical calculations were performed using Stata® software with determinations of p values and 95% CI where appropriate.
The study included an analysis of 5,971 NHANES participants for whom data on chronic kidney disease and kidney stones were available, of whom 521 reported a history of kidney stones. On multivariate analysis a history of kidney stones was associated with chronic kidney disease and treatment with dialysis (OR 1.50, 1.10-2.04, p = 0.013 and OR 2.37, 1.13-4.96, p = 0.025, respectively). This difference appeared to be driven by women, where a history of kidney stones was associated with a higher prevalence of chronic kidney disease (OR 1.76, 1.13-2.763, p = 0.016) and treatment with dialysis (OR 3.26, 1.48-7.16, p = 0.004). There was not a significant association between kidney stone history and chronic kidney disease or treatment with dialysis in men.
Kidney stone history is associated with an increased risk of chronic kidney disease and treatment with dialysis among women even after adjusting for comorbid conditions. Large scale prospective studies are needed to further characterize the relationship between nephrolithiasis and chronic kidney disease.
我们研究肾结石病作为慢性肾脏病、终末期肾病及透析治疗潜在危险因素的情况。
对2007 - 2010年美国国家健康与营养检查调查（NHANES）数据库中患有肾结石病史的患者进行查询。还评估了人口统计学和合并症情况，包括年龄、性别、体重指数、糖尿病、糖化血红蛋白、高血压、痛风和吸烟情况。进行多变量分析以调整患者人口统计学和合并症因素，从而评估两组之间慢性肾脏病患病率及透析治疗情况的差异。通过询问“你是否曾患过肾结石？”来评估肾结石病史。慢性肾脏病定义为估算肾小球滤过率低于60毫升/分钟/1.73平方米和/或尿白蛋白与肌酐比值大于30毫克/克。使用Stata®软件进行统计计算，并在适当情况下确定p值和95%置信区间。
该研究纳入了5971名有慢性肾脏病和肾结石数据的NHANES参与者，其中521人报告有肾结石病史。多变量分析显示，肾结石病史与慢性肾脏病及透析治疗相关（比值比分别为1.50，95%置信区间为1.10 - 2.04，p = 0.013；以及比值比为2.37，95%置信区间为1.13 - 4.96，p = 0.025）。这种差异似乎在女性中更为明显，肾结石病史与慢性肾脏病患病率较高相关（比值比为1.76，95%置信区间为1.13 - 2.763，p = 0.016）以及透析治疗相关（比值比为3.26，95%置信区间为1.48 - 7.16，p = 0.004）。在男性中，肾结石病史与慢性肾脏病或透析治疗之间无显著关联。
即使在调整合并症因素后，肾结石病史在女性中仍与慢性肾脏病风险增加及透析治疗相关。需要大规模前瞻性研究来进一步明确肾结石病与慢性肾脏病之间的关系。
