Urolithiasis and the risk of ESRD

Abstract

Background and objectives: The contribution of urolithiasis, if any, to the development of ESRD is unclear.

Design, setting, participants, & measurements: All stone formers in Olmsted County, Minnesota, first diagnosed between 1984 and 2008 were identified by diagnostic codes with up to four controls matched on age and sex. Charts were reviewed to validate symptomatic stone formers in a random subset. Incident ESRD events were identified by the US Renal Data System.

Results: Altogether, 51 stone formers and 75 controls developed ESRD among 6926 stone formers and 24,620 matched controls followed for a mean of 9 years. Stone formers had an increased risk of ESRD after adjusting for diabetes, hypertension, dyslipidemia, gout, and CKD (hazard ratio: 2.09; 95% confidence interval: 1.45-3.01). This increased risk of ESRD remained in the subset of 2457 validated symptomatic stone formers (hazard ratio: 1.95; 95% confidence interval: 1.09-3.49). The attributable risk of ESRD from symptomatic urolithiasis was 5.1% based on a prevalence of 5.4% for stone formers. For stone formers versus controls who developed ESRD, there was an increased likelihood of past hydronephrosis (44% versus 4%), recurrent urinary tract infections (26% versus 4%), acquired single kidney (15% versus 3%), neurogenic bladder (12% versus 1%), and ileal conduit (9% versus 0%), but not diabetes (32% versus 49%) or hypertension (44% versus 52%).

Conclusions: Symptomatic stone formers are at increased risk for ESRD independent of several cardiovascular risk factors. Other urological disease is relatively common among stone formers who develop ESRD.

Figure 1.

Risk of ESRD is in stone formers versus matched controls. Cumulative incidence (Kaplan–Meier method) of ESRD is significantly higher among the ICD-9–coded stone formers versus matched controls in (A) analysis group 2 (P=0.001), and also among the validated symptomatic stone formers versus matched controls who comprised (B) group 4 (P=0.01) in Olmsted County, Minnesota, from 1984 to 2003. ICD-9, International Classification of Diseases, Ninth Revision.