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Determinants of calcium and oxalate excretion in subjects with calcium nephrolithiasis: the role of metabolic syndrome traits

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Abstract

Background

The association of metabolic syndrome (MetS) traits with urinary calcium (UCE) or oxalate excretion (UOE) is uncertain in calcium stone formers (CSFs). Our aim was to investigate this association in a large group of Caucasian CSFs.

Methods

We retrospectively reviewed data of CSFs evaluated at our Kidney Stone Clinic from 1984 to 2015. Data on body mass index (BMI), MetS traits defined according to international consensus, family history of urolithiasis, anti-hypertensive treatments, calcemia, renal function, and 24-h urinary profile of lithogenic risk were collected. The association between MetS traits and UCE or UOE was tested with multivariate linear regression models accounting for a long list of potential confounders.

Results

We included 3003 CSFs, aged 44 ± 14 years. The prevalence of hypertension, diabetes, overweight (BMI ≥ 25 kg/m2) and dyslipidemia was 17, 2, 42 and 38%, respectively. Median values of UCE and UOE were 211 mg/24 h (IQR 143–296) and 28 mg/24 h (IQR 22–34), respectively. At a multivariate model, including age, sex, date of examination, drug treatments, family history, renal function, blood calcium and urinary factors as covariates, hypertension was a significant positive determinant of UCE (β ± SE 0.23 ± 0.07, p = 0.003), but overweight, dyslipidemia and diabetes were not. No MetS trait was significantly associated with UOE in multivariate models.

Conclusions

In a large group of Caucasian CSFs, hypertension was the only MetS trait significantly associated with UCE, while no MetS trait was associated with oxalate excretion.

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References

  1. Jeong IG, Kang T, Bang JK, Park J, Kim W, Hwang SS, Kim HK, Park HK (2011) Association between metabolic syndrome and the presence of kidney stones in a screened population. Am J Kidney Dis 58:383–388

    Article  PubMed  Google Scholar 

  2. West B, Luke A, Durazo-Arvizu RA, Cao G, Shoham D, Kramer H (2008) Metabolic syndrome and self-reported history of kidney stones: the National Health and Nutrition Examination Survey (NHANES III) 1988–1994. Am J Kidney Dis 51:741–747

    Article  PubMed  Google Scholar 

  3. Kohjimoto Y, Sasaki Y, Iguchi M, Matsumura M, Inagaki T, Hara I (2013) Association of metabolic syndrome traits and severity of kidney stones: results from a nationwide survey on urolithiasis in Japan. Am J Kidney Dis 61:923–929

    Article  PubMed  Google Scholar 

  4. Pak CYC, Sakhaee K, Moe OW et al (2011) Defining hypercalciuria in nephrolithiasis. Kidney Int 80:777–782

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Curhan GC, Willett WC, Speizer FE, Stampfer MJ (2001) Twenty-four hour urine chemistries and the risk of kidney stones among women and men. Kidney Int 59:2290–2298

    Article  CAS  PubMed  Google Scholar 

  6. Curhan GC, Taylor EN (2008) 24-h uric acid excretion and the risk of kidney stones. Kidney Int 73:489–496

    Article  CAS  PubMed  Google Scholar 

  7. Obligado SH, Goldfarb DS (2008) The association of nephrolithiasis with hypertension and obesity: a review. Am J Hypertens 21:257–264

    Article  CAS  PubMed  Google Scholar 

  8. Sakhaee K, Capolongo G, Maalouf NM, Pasch A, Moe OW, Poindexter J, Adams-Huet B (2012) Metabolic syndrome and the risk of calcium stones. Nephrol Dial Transpl 27:3201–3209

    Article  CAS  Google Scholar 

  9. Taylor EN, Curhan GC (2008) Determinants of 24-h urinary oxalate excretion. Clin J Am Soc Nephrol 3:1453–1460

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Nouvenne A, Ticinesi A, Allegri F, Guerra A, Guida L, Morelli I, Borghi L, Meschi T (2014) Twenty-five years of idiopathic calcium nephrolithiasis: has anything changed? Clin Chem Lab Med 52:337–344

    Article  CAS  PubMed  Google Scholar 

  11. Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC; Consensus Conference Group (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29:715–734

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Alberti KGMM, Eckel RH, Grundy SM et al (2009) Harmonizing the metabolic syndrome. A joint interim statement of the international diabetes federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640–1645

    Article  CAS  PubMed  Google Scholar 

  13. Barreira TV, Staiano AE, Harrington DM, Heymsfield SB, Smith SR, Bouchard C, Katzmarczyk PT (2012) Anthropometric correlates of total body fat, abdominal adiposity, and cardiovascular disease risk factors in a biracial sample of men and women. Mayo Clin Proc 87:452–460

    Article  PubMed  PubMed Central  Google Scholar 

  14. Prezioso S, Strazzullo P, Lotti T, Bianchi G, Borghi L, Caione P, Carini M, Caudarella R, Gambaro G, Gelosa M, Guttilla A, Illiano E, Marangella M, Meschi T, Messa P, Miano R, Napodano G, Nouvenne A, Rendina D, Rocco F, Rosa M, Sanseverino R, Salerno A, Spatafora S, Tasca A, Ticinesi A, Travaglini F, Trinchieri A, Vespasiani G, Zattoni F (2015) Dietary treatment of urinary risk factors for renal stone formation. A review of CLU working group. Arch Ital Urol Androl 87:105–120

    Article  CAS  PubMed  Google Scholar 

  15. Borghi L, Meschi T, Guerra A, Briganti A, Schianchi T, Allegri F, Novarini A (1999) Essential arterial hypertension and stone disease. Kidney Int 55:2397–2406

    Article  CAS  PubMed  Google Scholar 

  16. Eisner BH, Porten SP, Bechis SK, Stoller ML (2010) Hypertension is associated with increased urinary calcium excretion in patients with nephrolithiasis. J Urol 183:576–579

    Article  CAS  PubMed  Google Scholar 

  17. Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi T (2016) Salt and nephrolithiasis. Nephrol Dial Transplant 31:39–45

    Article  CAS  Google Scholar 

  18. Levy FL, Adams-Huet B, Pak CY (1995) Ambulatory evaluation of nephrolithiasis: an update of a 1980 protocol. Am J Med 98:50–59

    Article  CAS  PubMed  Google Scholar 

  19. Guerra A, Folesani G, Nouvenne A, Ticinesi A, Allegri F, Pinelli S, Prati B, Morelli I, Guida L, Aloe R, Meschi T (2016) Family history influences clinical course of idiopathic calcium nephrolithiasis: case-control study of a large cohort of Italian patients. J Nephrol 29:645–651

    Article  PubMed  Google Scholar 

  20. Madore F, Stampfer MJ, Willett WC, Speizer FE, Curhan GC (1998) Nephrolithiasis and risk of hypertension in women. Am J Kidney Dis 32:802–807

    Article  CAS  PubMed  Google Scholar 

  21. Madore F, Stampfer MJ, Rimm EB, Curhan GC (1998) Nephrolithiasis and risk of hypertension. Am J Hypertens 11:46–53

    Article  CAS  PubMed  Google Scholar 

  22. Taylor EN, Mount DB, Forman JP, Curhan GC (2006) Association of prevalent hypertension with 24-h urinary excretion of calcium, citrate, and other factors. Am J Kidney Dis 47:780–789

    Article  CAS  PubMed  Google Scholar 

  23. Kim YJ, Kim CH, Sung EJ, Kim SR, Shin HC, Jung WJ (2013) Association of nephrolithiasis with metabolic syndrome and its components. Metabolism 62:808–813

    Article  CAS  PubMed  Google Scholar 

  24. Miranda Torricelli FC, De SK, Gebreselassie S, Sarkissian C, Monga M (2014) Dyslipidemia and kidney stone risk. J Urol 191:667–672

    Article  Google Scholar 

  25. Eisner BH, Eisenberg ML, Stoller ML (2010) Relationship between body mass index and quantitative 24-h urine chemistries in patients with nephrolithiasis. Urology 75:1289–1293

    Article  PubMed  Google Scholar 

  26. Shavit L, Ferraro PM, Johri N, Robertson W, Walsh SB, Moochhala S, Unwin R (2015) Effect of being overweight on urinary metabolic risk factors for kidney stone formation. Nephrol Dial Transplant 30:607–613

    Article  CAS  PubMed  Google Scholar 

  27. Nouvenne A, Ticinesi A, Guerra A, Folesani G, Allegri F, Pinelli S, Baroni P, Pedrazzoni M, Lippi G, Terranegra A, Dogliotti E, Soldati L, Borghi L, Meschi T (2013) Influence of lean and fat mass on bone mineral density and on urinary stone risk factors in healthy women. J Transl Med 11:248

    Article  PubMed  PubMed Central  Google Scholar 

  28. Maalouf NM, Cameron MA, Moe OW, Sakhaee K (2010) Metabolic basis for low urine pH in type 2 diabetes. Clin J Am Soc Nephrol 5:1277–1281

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Yoon V, Adams-Huet B, Sakhaee K, Maalouf NM (2013) Hyperinsulinemia and urinary calcium excretion in calcium stone formers with idiopathic hypercalciuria. J Clin Endocrinol Metab 98:2589–2594

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Eisner BH, Porten SP, Bechis SK, Stoller ML (2010) Diabetic kidney stone formers excrete more oxalate and have lower urine pH than nondiabetic stone formers. J Urol 183:2244–2248

    Article  CAS  PubMed  Google Scholar 

  31. Bobulescu IA, Maalouf NM, Capolongo G, Adams-Huet B, Rosenthal TR, Moe OW, Sakhaee K (2013) Renal ammonium excretion after an acute acid load: blunted response in uric acid stone formers but not in patients with type 2 diabetes. Am J Physiol Renal Physiol 305:F1498–F1503

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to thank Dr. Nicoletta Cerundolo for precious assistance in data management and collection.

Author information

Authors and Affiliations

  1. Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy

    Andrea Ticinesi, Angela Guerra, Franca Allegri, Antonio Nouvenne, Marcello Maggio, Fulvio Lauretani, Loris Borghi & Tiziana Meschi

  2. Dipartimento Medico Geriatrico-Riabilitativo, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

    Andrea Ticinesi, Angela Guerra, Franca Allegri, Antonio Nouvenne, Marcello Maggio, Fulvio Lauretani, Loris Borghi & Tiziana Meschi

  3. Dipartimento d’Emergenza Urgenza e Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

    Gianfranco Cervellin

Authors
  1. Andrea Ticinesi
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  2. Angela Guerra
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  3. Franca Allegri
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  4. Antonio Nouvenne
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  5. Gianfranco Cervellin
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  6. Marcello Maggio
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  7. Fulvio Lauretani
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  8. Loris Borghi
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  9. Tiziana Meschi
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Contributions

Research idea and study design: AT, LB, TM; data analysis/interpretation: AT, AG, FA, AN; statistical analysis: MM, FL; supervision: LB, TM; revision of the manuscript for important intellectual content: GC, MM, FL.

Corresponding author

Correspondence to Andrea Ticinesi.

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Conflict of interest

All the authors have read and understood the Journal of Nephrology’s policy on disclosing conflict of interest. All the authors have no conflict of interest to declare, with the exception of Tiziana Meschi, who received an unconditioned grant for research in the field of nephrolithiasis by Acqua&Terme Fiuggi S.p.A. (Fiuggi, Frosinone, Italy).

Ethical approval

The study protocol was approved by the local Ethics Committee (ID 16280). All investigations were carried out in conformity with the Declaration of Helsinki principles.

Informed consent

Written informed consent was obtained from participants, according to current legislation for retrospective studies.

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Ticinesi, A., Guerra, A., Allegri, F. et al. Determinants of calcium and oxalate excretion in subjects with calcium nephrolithiasis: the role of metabolic syndrome traits. J Nephrol 31, 395–403 (2018). https://doi.org/10.1007/s40620-017-0453-3

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  • DOI: https://doi.org/10.1007/s40620-017-0453-3

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