Prochaska Megan, Adeola Gloria, Vetter Noah, Mirmira Raghavendra G, Coe Fredric, Worcester Elaine
Department of Medicine, University of Chicago, Chicago IL.
Kidney Med. 2024 Oct 18;6(12):100922. doi: 10.1016/j.xkme.2024.100922. eCollection 2024 Dec.
RATIONAL & OBJECTIVE: Diabetes and uric acid kidney stones are strongly associated. Patients with calcium kidney stones also have higher risk of developing diabetes compared with nonkidney stone patients yet this has not been further investigated. We aimed to characterize insulin resistance in calcium kidney stone patients.
Observational.
SETTING & POPULATION: This study was performed in the University of Chicago Clinical Research Center. Kidney stone patients (N = 42) were selected for having idiopathic hypercalciuria and calcium stones with no other medical conditions, and controls (N = 27) were healthy.
All participants presented to the Clinical Research Center in a fasting state and at least 2 timed fasting blood and urine collections were collected before a fixed breakfast. Six additional timed blood and urine collections were performed after breakfast.
We compared fasting and fed indices of insulin resistance between the groups.
We used tests and multivariable linear regression models. A sensitivity analysis removing all patients who had ever been on a thiazide diuretic was also performed.
In separate multivariable linear models, kidney stone patients had higher fasting serum insulin levels (24 (3-46 pmol/L), = 0.03) and higher homeostatic model of insulin resistance (HOMA-IR) (1.0 (0.2-1.8), = 0.02). In separate multivariable linear models, kidney stone patients had higher fed serum glucose levels (10 (2-18 mg/dL), = 0.01). Results were similar in a sensitivity analysis removing all patients who had ever been on a thiazide diuretic. There were no differences in urine composition based on HOMA-IR levels.
Single institution. Small sample size limited subanalyses by different calcium stone types.
Calcium kidney stone patients without diabetes or other medical conditions demonstrated signs of insulin resistance compared with healthy matched controls.
糖尿病与尿酸肾结石密切相关。与非肾结石患者相比，钙肾结石患者患糖尿病的风险也更高，但这一点尚未得到进一步研究。我们旨在描述钙肾结石患者的胰岛素抵抗特征。
观察性研究。
本研究在芝加哥大学临床研究中心进行。选择患有特发性高钙尿症和钙结石且无其他疾病的肾结石患者（N = 42），对照组（N = 27）为健康人群。
所有参与者均在空腹状态下到临床研究中心就诊，在固定早餐前至少进行2次定时空腹血样和尿样采集。早餐后再进行6次定时血样和尿样采集。
我们比较了两组之间空腹和进食状态下的胰岛素抵抗指标。
我们使用了检验和多变量线性回归模型。还进行了一项敏感性分析，排除了所有曾服用噻嗪类利尿剂的患者。
在单独的多变量线性模型中，肾结石患者的空腹血清胰岛素水平较高（24（3 - 46 pmol/L），P = 0.03），胰岛素抵抗稳态模型（HOMA - IR）也较高（1.0（0.2 - 1.8），P = 0.02）。在单独的多变量线性模型中，肾结石患者的进食后血清葡萄糖水平较高（10（2 - 18 mg/dL），P = 0.01）。在排除所有曾服用噻嗪类利尿剂患者的敏感性分析中，结果相似。基于HOMA - IR水平，尿成分无差异。
单中心研究。样本量小限制了按不同钙结石类型进行的亚组分析。
与健康匹配对照组相比，无糖尿病或其他疾病的钙肾结石患者表现出胰岛素抵抗迹象。
