Skip to main content
SpringerLink
Log in

A path analysis to investigate the interaction between serum, urinary and demographic factors influencing urine calcium in kidney stone formers

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

Hypercalciuria is one of the most important urinary risk factors in kidney stone formers. This study aimed to delineate the interaction of some demographic, serum, and urinary risk factors influencing 24-h urinary (24-U) calcium excretion.

Methods

This study was secondary data analysis, using data from 593 kidney stone patients referred to the Labbafinejad kidney stone prevention clinic from March 2015 to May 2019. The study considered serum, urinary and demographic factors that interact to influence 24-U calcium using path analysis. In addition to the direct impact of predictors on the 24-U calcium, this analysis considered the effects of the predictors on the 24-U calcium transmitted by a mediating variable named indirect effects.

Results

The results showed that age indirectly affected on 24-U calcium through 25-hydroxy vitamin D (25(OH)D), serum and 24-U creatinine. As well, weight had an indirect effect through 24-urine metabolites (creatinine, citrate, urea, and sodium). Among serum variables, PTH and creatinine significantly directly affected on 24-U calcium. In comparison, 25(OH)D and phosphorus appeared to influence 24-U calcium indirectly through serum parathormone. Regarding 24-U metabolites, sodium, urea, and citrate had a significant direct effect on 24-U calcium. Moreover, 24-U creatinine has a significant direct and indirect effect on 24-U calcium through citrate and urea as mediator variables.

Conclusion

Serum 25(OH)D and phosphorus, along with age and weight, indirectly affected urinary calcium through a third variable. Other variables (PTH, serum creatinine, and 24-U sodium, urea, and citrate) showed a direct effect on 24-U calcium excretion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and material

Data and materials can be made available upon request.

References

  1. Bartoletti R, Cai T, Mondaini N, Melone F, Travaglini F, Carini M et al (2007) Epidemiology and risk factors in urolithiasis. Urol Int 79(Suppl. 1):3–7

    Article  PubMed  Google Scholar 

  2. Stamatelou KK, Francis ME, Jones CA, Nyberg LM Jr, Curhan GC (2003) Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int 63(5):1817–1823

    Article  PubMed  Google Scholar 

  3. Rule AD, Krambeck AE, Lieske JC (2011) Chronic kidney disease in kidney stone formers. Clin J Am Soc Nephrol 6(8):2069–2075

    Article  PubMed  PubMed Central  Google Scholar 

  4. Partin AW, Wein AJ, Kavoussi LR, Peters CA, Dmochowski RR (2020) Campbell Walsh Wein urology, E-Book. Elsevier Health Sciences

    Google Scholar 

  5. Coe FL, Parks JH, Asplin JR (1992) The pathogenesis and treatment of kidney stones. N Engl J Med 327(16):1141–1152

    Article  CAS  PubMed  Google Scholar 

  6. Rathod A, Bonny O, Guessous I, Suter PM, Conen D, Erne P et al (2015) Association of urinary calcium excretion with serum calcium and vitamin D levels. Clin J Am Soc Nephrol 10(3):452–462

    Article  CAS  PubMed  Google Scholar 

  7. Kim WT, Kim Y-J, Yun SJ, Shin K-S, Choi YD, Lee SC et al (2014) Role of 1, 25-dihydroxy vitamin D3 and parathyroid hormone in urinary calcium excretion in calcium stone formers. Yonsei Med J 55(5):1326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Taylor EN, Curhan GC (2009) Demographic, dietary, and urinary factors and 24-h urinary calcium excretion. Clin J Am Soc Nephrol CJASN 4(12):1980–1987

    Article  CAS  PubMed  Google Scholar 

  9. Tavasoli S, Taheri F, Amiri FB, Borumandnia N, Basiri A, Parvin M, Taheri M (2021) The prevalence of vitamin D deficiency, its predisposing factors and association with 24-hour urine metabolites among Iranian kidney stone formers. Iran J Kidney Dis 15(4):263

    PubMed  Google Scholar 

  10. Williams JC, Gambaro G, Rodgers A, Asplin J, Bonny O, Costa-Bauzá A et al (2020) Urine and stone analysis for the investigation of the renal stone former: a consensus conference. Urolithiasis. 46:1–16

    Google Scholar 

  11. Powell CR, Stoller ML, Schwartz BF, Kane C, Gentle DL, Bruce JE et al (2000) Impact of body weight on urinary electrolytes in urinary stone formers. Urology 55(6):825–830

    Article  CAS  PubMed  Google Scholar 

  12. Oh SW, Han KH, Han SY, Koo HS, Kim S, Chin HJ (2015) Association of sodium excretion with metabolic syndrome, insulin resistance, and body fat. Medicine 94(39):e1650

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Oh SW, Koo HS, Han KH, Han SY, Chin HJ (2017) Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PLoS ONE 12(12):e0188770

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fappi A, Mittendorfer B (2020) Dietary protein intake and obesity-associated cardiometabolic function. Curr Opin Clin Nutr Metab Care 23(6):380

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mittendorfer B, Klein S, Fontana L (2020) A word of caution against excessive protein intake. Nat Rev Endocrinol 16(1):59–66

    Article  PubMed  Google Scholar 

  16. Berlin T, Björkhem I, Collste L, Holmberg I, Wijkström H (1982) Relation between hypercalciuria and vitamin D3-status in patients with urolithiasis. Scand J Urol Nephrol 16(3):269–273

    Article  CAS  PubMed  Google Scholar 

  17. Giannini S, Nobile M, Castrignano R, Pati T, Tasca A, Villi G et al (1993) Possible link between vitamin D and hyperoxaluria in patients with renal stone disease. Clin Sci 84(1):51–54

    Article  CAS  Google Scholar 

  18. Jarrar K, Amasheh R, Graef V, Weidner W (1996) Relationship between 1, 25-dihydroxyvitamin-D, calcium and uric acid in urinary stone formers. Urol Int 56(1):16–20

    Article  CAS  PubMed  Google Scholar 

  19. Netelenbos JC, Jongen MJ, van der Vijgh WJ, Lips P, van Ginkel FC (1985) Vitamin D status in urinary calcium stone formation. Arch Intern Med 145(4):681–684

    Article  CAS  PubMed  Google Scholar 

  20. Eisner BH, Thavaseelan S, Sheth S, Haleblian G, Pareek G (2012) Relationship between serum vitamin D and 24-hour urine calcium in patients with nephrolithiasis. Urology 80(5):1007–1010

    Article  PubMed  Google Scholar 

  21. Tang J, McFann KK, Chonchol MB (2012) Association between serum 25-hydroxyvitamin D and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988–94. Nephrol Dial Transplant 27(12):4385–4389

    Article  CAS  PubMed  Google Scholar 

  22. Hu H, Zhang J, Lu Y, Zhang Z, Qin B, Gao H et al (2017) Association between circulating vitamin D level and urolithiasis: a systematic review and meta-analysis. Nutrients 9(3):301

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vezzoli G, Soldati L, Arcidiacono T, Terranegra A, Biasion R, Russo CR et al (2005) Urinary calcium is a determinant of bone mineral density in elderly men participating in the InCHIANTI study. Kidney Int 67(5):2006–2014

    Article  PubMed  Google Scholar 

  24. Taheri M, Tavasoli S, Shokrzadeh F, Amiri FB, Basiri A (2019) Effect of vitamin D supplementation on 24-hour urine calcium in patients with calcium Urolithiasis and vitamin D deficiency. Int Braz J Urol 45(2):340–346

    Article  PubMed  PubMed Central  Google Scholar 

  25. Potts JT (2005) Parathyroid hormone: past and present. J Endocrinol 187(3):311–325

    Article  CAS  PubMed  Google Scholar 

  26. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281

    Article  CAS  PubMed  Google Scholar 

  27. Peacock M, Robertson W, Nordin B (1969) Relation between serum and urinary calcium with particular reference to parathyroid activity. The Lancet 293(7591):384–386

    Article  Google Scholar 

  28. Muldowney FP, Freaney R, Moloney MF (1982) Importance of dietary sodium in the hypercalciuria syndrome. Kidney Int 22(3):292–296

    Article  CAS  PubMed  Google Scholar 

  29. Sakhaee K, Harvey JA, Padalino PK, Whitson P, Pak CY (1993) The potential role of salt abuse on the risk for kidney stone formation. J Urol 150(2 Part 1):310–312

    Article  CAS  PubMed  Google Scholar 

  30. Mahan L, Food RJKs (2016) The Nutrition Care Process. Saunders, Philadelphia

    Google Scholar 

  31. Song Y, Hernandez N, Shoag J, Goldfarb DS, Eisner BH (2016) Potassium citrate decreases urine calcium excretion in patients with hypocitraturic calcium oxalate nephrolithiasis. Urolithiasis 44(2):145–148

    Article  CAS  PubMed  Google Scholar 

  32. Moseley KF, Weaver CM, Appel L, Sebastian A, Sellmeyer DE (2013) Potassium citrate supplementation results in sustained improvement in calcium balance in older men and women. J Bone Miner Res 28(3):497–504

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No specific funding for this.

Author information

Authors and Affiliations

  1. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

    Fatemeh Taheri

  2. Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maryam Taheri, Sanaz Tavasoli, Abbas Basiri & Nasrin Borumandnia

Authors
  1. Fatemeh Taheri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maryam Taheri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sanaz Tavasoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abbas Basiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nasrin Borumandnia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: NB, ST, MT, FT; Acquisition of Data: ST, and MT; Methodology, analysis, NB; Writing-original draft preparation, FT, and NB; Writing-review and editing, FT, ST, MT, NB; Administrative and Supervision, AB.

Corresponding author

Correspondence to Nasrin Borumandnia.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The Ethics Committee of the Urology and Nephrology Research Center at Shahid Beheshti University of Medical Sciences approved the study (ethic code, IR. SBMU.UNRC.1395.15).

Consent for publication

Not Applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taheri, F., Taheri, M., Tavasoli, S. et al. A path analysis to investigate the interaction between serum, urinary and demographic factors influencing urine calcium in kidney stone formers. Int Urol Nephrol 55, 1829–1836 (2023). https://doi.org/10.1007/s11255-023-03461-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-023-03461-z

Keywords

Search

Navigation