Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review

Abstract

Introduction

Current trends show a rising incidence of kidney stone disease (KSD) globally, with a lifetime risk of 10% and increasing hospital admissions. However, it is not perceived as a life-threatening condition and there are no publications examining its mortality rate. The aim of this review was to report on the number of KSD mortalities in the literature from the past two decades, identify risk factors, and to summarize their key learning points.

Methods

A search was conducted for full-text English language articles that reported on KSD associated mortality, following intervention or conservative treatment, published between 1999 and 2017, using PubMed, MEDLINE, EMBASE, Scopus, CINAHL, Clinicaltrials.gov, Google Scholar and The Cochrane Library. Study quality and risk of bias assessment was undertaken using a validated critical appraisal tool from the Joanna Briggs Institute.

Results

Of the 2786 articles identified, 34 were included. Of the total number of reported mortalities (2550), 21% were related to intervention. Sepsis was the leading cause of mortality. Risk factors identified were patients with multiple co-morbidities, spinal cord injury or neurogenic bladder and high stone burden. The main recommendations suggested were to treat pre-operative UTI or use prophylactic antibiotics and to reduce operative duration. The included studies were of moderate to good quality.

Conclusion

Pre-procedural optimization of the patients is the key to avoiding KSD mortality, and care should be taken in patients with multiple co-morbidities. Surgeons should meticulously plan for patients with high stone burden to reduce their operative time, as mortality can be procedural related.

Appendix 1: Search matrix used for study

((((((((((((((((urolithiasis) OR renal stone*) OR kidney stone*) OR urinary calculi)) OR urinary stone*)) OR renal calculi)) AND life-threatening)) OR ((((((((((urolithiasis) OR renal stone*) OR kidney stone*) OR urinary calculi)) OR urinary stone*)) OR renal calculi)) AND mortality)) OR ((((((((((urolithiasis) OR renal stone*) OR kidney stone*) OR urinary calculi)) OR urinary stone*)) OR renal calculi)) AND death))) OR ((((((((ureteroscopy) AND mortality)) OR ((ureteroscopy) AND death)) OR ((ureteroscopy) AND life-threatening)) OR ((URS) AND mortality)) OR ((URS) AND life-threatening)) OR ((URS) AND death))) OR ((((((((percutaneous nephrolithotomy) AND mortality)) OR ((percutaneous nephrolithotomy) AND death)) OR ((percutaneous nephrolithotomy) AND life-threatening)) OR ((PCNL) AND mortality)) OR ((PCNL) AND death)) OR ((PCNL) AND life-threatening))) OR ((((((((shockwave lithotripsy) AND mortality)) OR ((shockwave lithotripsy) AND death)) OR ((shockwave lithotripsy) AND life-threatening)) OR ((SWL) AND mortality)) OR ((SWL) AND death)) OR ((SWL) AND life-threatening)).

(((((((((kidney stone) AND “active surveillance”)) OR ((renal stone) AND “active surveillance”)) OR ((renal calculi) AND “active surveillance”)) OR ((urinary stone) AND “active surveillance”)) OR ((urinary calculi) AND “active surveillance”)) OR ((urolithiasis) AND “active surveillance”))) OR ((((((((urolithiasis) AND “no treatment”)) OR ((urinary calculi) AND “no treatment”)) OR ((urinary stones) AND “no treatment”)) OR ((renal calculi) AND “no treatment”)) OR ((renal stones) AND “no treatment”)) OR ((kidney stones) AND “no treatment”)).

(((((((kidney stone) AND conservative)) OR ((renal stone) AND conservative)) OR ((renal calculi) AND conservative)) OR ((urinary stone) AND conservative)) OR ((urinary calculi) AND conservative)) OR ((urolithiasis) AND conservative).