Risk factors for nephrolithiasis formation: an umbrella review

Abstract

Objective: Nephrolithiasis is prevalent and burdensome worldwide. At present, evidence on the risk factors for nephrolithiasis is unconsolidated and the associations remain uncertain. The authors systematically evaluate the robustness of the meta-analytic evidence and aid more reliable interpretations of the epidemiological relationships.

Methods: The authors conducted a comprehensive review of the meta-analyses, screened the included studies with the aid of the AMSTAR 2 evaluation tool, and then used R (4.1.1) software to perform data analysis to evaluate the association between candidate risk factors and kidney stones, and evaluated the credibility of the evidence of the association between risk factors and kidney stones according to the GRADE classification, and finally obtained the strength and effectiveness of the association.

Results: The authors finally included 17 meta-analyses regarding 46 risk factors, 34 of which (73.9%) showed statistically significant association with nephrolithiasis. Among the significant associations, the authors found that waist circumference, BMI, dietary intake and fructose intake were positively correlated with the occurrence and development of nephrolithiasis. Caffeine, dietary fiber and DASH-diet showed a tendency to reduce kidney stones. Interestingly, calcium supplementation, dietary calcium, and vitamin D, which are widely believed to be responsible for stone formation, made no difference or even reduced the risk of nephrolithiasis.

Conclusions: The authors' study demonstrates the suggestive causal (central obesity, type 2 diabetes, gout, dietary sodium, fructose intake and higher temperatures) risk factors of nephrolithiasis. The authors also demonstrate the suggestive causal (coffee/alcohol/beer intake, dietary calcium and DASH-diet) protective factors of nephrolithiasis. To provide epidemiological basis for the treatment and prevention of nephrolithiasis.

Figure 1

Flow diagram to demonstrate the search and selection process in umbrella review.

Figure 2

Histogram demonstrating the summary results for number of meta-analyses included and its corresponding class of umbrella review and certain of evidence.

Figure 3

Forest plot to demonstrate the main results of umbrella review. Purple box and solid line are the effect size with its 95% CIs of meta using random-effect model, and blue dotted line represent 95% prediction intervals. 2hGlu, 2-h glucose after an oral glucose challenge; 25(OH)D, 25-Hydroxyvitamin D; HDL-C, high-density lipoprotein cholesterol; NAFLD, non-alcoholic fatty liver disease; T2D, type 2 diabetes.