Feghali Karen, Li Xilong, Maalouf Naim M
Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas.
Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas.
Kidney360. 2024 Nov 1;5(11):1706-1712. doi: 10.34067/KID.0000000580. Epub 2024 Sep 18.
In obese kidney stone formers, weight loss with glucagon-like peptide-1 (GLP)-based therapy was associated with a significant decline in 24-hour urine oxalate and sulfate excretion rates. Weight loss through GLP-based therapies was associated with nonsignificant changes in urine saturation indices. In obese kidney stone formers, GLP-based therapy appears to be a safe option for weight loss on the basis of 24-hour urine studies.
Obesity is an independent risk factor of incident and recurrent nephrolithiasis. The effect of weight loss through glucagon-like peptide 1 (GLP-1) receptor agonists and dual GLP-1/gastric inhibitory polypeptide receptor agonists (GLP-based therapies) on nephrolithiasis is not well understood. This study examined the changes in 24-hour urine chemistry assessing for stone risk during weight loss through GLP-based therapies.
This retrospective analysis identified adult stone formers followed at our academic institution's weight wellness clinic between September 2015 and August 2023 and included patients with at least two 24-hour urine collections for stone risk assessment. 24-hour urine parameters before and during weight loss in patients on GLP-based therapies were compared.
Forty-four obese patients with nephrolithiasis experienced significant weight reduction (−6.6±7.3 kg, < 0.001) over a median 1.1 years of follow-up with GLP-based therapies. During this period, there was a significant decrease in 24-hour urine oxalate (40±16 to 32±11 mg/d, = 0.002), sulfate (21±10 to 17±9 mmol/d, = 0005), and ammonium (35±22 to 29±15 mEq/d, = 0.01) excretion rates. There were nonsignificant changes in urine calcium, citrate, uric acid, pH, phosphorus, sodium, potassium, magnesium, chloride, creatinine, or total volume. In addition, there was no statistical difference in urine supersaturation indices with respect to calcium oxalate, calcium phosphate, and uric acid.
Our results indicate that weight loss through GLP-based therapies is not associated with prolithogenic changes in 24-hour urine chemistry in patients with nephrolithiasis, unlike what happens with other weight loss modalities.
在肥胖的肾结石患者中，基于胰高血糖素样肽-1（GLP）的疗法实现体重减轻与24小时尿草酸和硫酸盐排泄率显著下降有关。通过基于GLP的疗法实现体重减轻与尿饱和度指数的变化不显著有关。在肥胖的肾结石患者中，基于24小时尿液研究，基于GLP的疗法似乎是一种安全的减肥选择。
肥胖是新发和复发性肾结石的独立危险因素。通过胰高血糖素样肽1（GLP-1）受体激动剂和双GLP-1/胃抑制多肽受体激动剂（基于GLP的疗法）实现体重减轻对肾结石的影响尚不清楚。本研究通过基于GLP的疗法在体重减轻期间评估结石风险，检测了24小时尿液化学成分的变化。
这项回顾性分析确定了2015年9月至2023年8月在我们学术机构的体重健康诊所就诊的成年结石患者，并纳入了至少有两次24小时尿液收集用于结石风险评估的患者。比较了接受基于GLP疗法的患者在体重减轻之前和期间的24小时尿液参数。
44名肥胖的肾结石患者在接受基于GLP的疗法的中位随访1.1年期间体重显著减轻（-6.6±7.3kg，<0.001）。在此期间，24小时尿草酸（40±16至32±11mg/d，=0.002）、硫酸盐（21±10至17±9mmol/d，=0.005）和铵（35±22至29±15mEq/d，=0.01）排泄率显著下降。尿钙、柠檬酸盐、尿酸、pH值、磷、钠、钾、镁、氯、肌酐或总体积无显著变化。此外，草酸钙、磷酸钙和尿酸的尿过饱和指数无统计学差异。
我们的结果表明，与其他减肥方式不同，通过基于GLP的疗法实现体重减轻与肾结石患者24小时尿液化学成分的促结石变化无关。
