Xi Yujia, Liu Xuchang, Wang Shuang, Wang Wei, Guo Qiang, Wang Jingqi
Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China.
Department of Urology, The First Hospital of Shanxi Medical University, Taiyuan, China.
Urolithiasis. 2023 Apr 4;51(1):63. doi: 10.1007/s00240-023-01438-2.
The causality between the urinary sodium-potassium ratio and upper urinary calculi has not been clarified and easily affected by confounders. We performed two-sample and multivariable Mendelian randomization (MR) analysis to evaluate the potential causal role of the urinary sodium-potassium ratio in upper urinary calculi. Data of the urinary sodium-potassium ratio (N = 326,938), upper urinary calculi (N = 337,199), and confounding factors including BMI (N = 336,107), ever-smoke (N = 461,066), hypertension (N = 218,754), diabetes (N = 218,792), and alcohol intake frequency (N = 462,346) were obtained from the IEU OpenGWAS Project database. The inverse-variance weighted (IVW), weighted median, and MR-Egger methods were used to estimate MR effects. The MR-Egger intercept test, Cochran's Q test, MR-PRESSO, leave-one-out method, and funnel plot were used for sensitivity analysis. A causal relationship was found between the urinary sodium-potassium ratio and upper urinary calculi (OR = 1.008, 95% CI = 1.002-1.013, P = 0.011). FinnGen data supported this conclusion (OR = 2.864, 95% CI = 1.235-6.641, P = 0.014). The multivariable Mendelian randomization analysis result showed that after adjusting for the effects of five confounders, the urinary sodium-potassium ratio was still positively correlated with upper urinary calculi (OR = 1.005, 95% CI = 1.001-1.009, P = 0.012). This study demonstrated a positive causal association between the urinary sodium-potassium ratio and upper urinary calculi using MR analysis. Timely identification of changes in urine composition and dietary regulation of sodium and potassium intake could greatly reduce the incidence of future urinary calculi.
尿钠钾比值与上尿路结石之间的因果关系尚未明确，且易受混杂因素影响。我们进行了两样本和多变量孟德尔随机化（MR）分析，以评估尿钠钾比值在上尿路结石中的潜在因果作用。尿钠钾比值（N = 326,938）、上尿路结石（N = 337,199）以及包括体重指数（BMI，N = 336,107）、既往吸烟史（N = 461,066）、高血压（N = 218,754）、糖尿病（N = 218,792）和饮酒频率（N = 462,346）等混杂因素的数据均来自IEU OpenGWAS项目数据库。采用逆方差加权（IVW）、加权中位数和MR-Egger方法估计MR效应。使用MR-Egger截距检验、Cochran's Q检验、MR-PRESSO、留一法和漏斗图进行敏感性分析。发现尿钠钾比值与上尿路结石之间存在因果关系（比值比[OR]=1.008，95%置信区间[CI]=1.002 - 1.013，P = 0.011）。芬兰基因数据支持这一结论（OR = 2.864，95% CI = 1.235 - 6.641，P = 0.014）。多变量孟德尔随机化分析结果显示，在调整五个混杂因素的影响后，尿钠钾比值仍与上尿路结石呈正相关（OR = 1.005，95% CI = 1.001 - 1.009，P = 0.012）。本研究通过MR分析证明了尿钠钾比值与上尿路结石之间存在正向因果关联。及时识别尿液成分变化并对钠钾摄入进行饮食调节，可大幅降低未来尿路结石的发病率。
