66 DIABETIC SEVERITY AND RISK OF KIDNEY STONE DISEASE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-Based Medicine & Outcomes (II)1 Apr 201366 DIABETIC SEVERITY AND RISK OF KIDNEY STONE DISEASE Aviva Weinberg, Chirag Patel, Glenn Chertow, and John Leppert Aviva WeinbergAviva Weinberg Stanford, CA More articles by this author , Chirag PatelChirag Patel Stanford, CA More articles by this author , Glenn ChertowGlenn Chertow Stanford, CA More articles by this author , and John LeppertJohn Leppert Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Diabetes mellitus (DM), obesity, and metabolic syndrome are associated with kidney stone disease. We investigated the associations among the presence and severity of diabetes, glycemic control and insulin resistance with kidney stone disease in a nationally representative data sample. METHODS We analyzed adult (age >20) participants in the 2007-2010 NHANES survey (N =12,153). A history of kidney stone disease was obtained by self-report. The presence of DM was defined by a self-reported history, DM related medication usage (insulin and oral hypoglycemic agents), and reported DM comorbidity (retinopathy). Insulin resistance was estimated using fasting plasma insulin (FPI) levels and the homeostasis model assessment of insulin resistance (HOMA-IR) definition. We classified glycemic control using HbA1c and fasting plasma glucose levels (FPG). Univariate logistic regression was used to calculate odds ratios (OR) for each measure of diabetic severity. We then constructed multivariate logistic regression models adjusting for patient age, gender, race/ethnicity, smoking history, and BMI (model A) as well additional laboratory values including serum uric acid, serum calcium, and serum creatinine (model B). All analyses accounted for the complex NHANES sample design. RESULTS Univariate predictors of kidney stone disease included a self-reported history of diabetes (OR 2.44, CI 1.84-3.25) and history of insulin use (OR 3.31, CI 2.02-5.45). Patients with prediabetic range and diabetic range FPG had increased odds of kidney stone disease, OR 1.28 (CI 0.95-1.72) and OR 2.29 (CI 1.68-3.12), respectively. Patients with prediabetic and diabetic range HgbA1c values had ORs of 1.68 (CI=1.17-2.42) and 2.82 (1.98-4.02), respectively. In the multivariate model, a history of DM, the use of insulin, FPI levels and elevated HgbA1c levels remained significantly associated with kidney stone disease. These associations remained after further adjustment for serum uric acid, calcium and creatinine levels in Model B. (Table 1). CONCLUSIONS The severity of diabetes, as estimated by measures of glycemic control (fasting plasma glucose levels, HbA1c), and insulin resistance (insulin use, fasting plasma insulin levels, and HOMA-IR) are associated with increased odds of kidney stone disease. Univariate and Multivariate Regression Models Predicting History of Kidney Stones Univariate, Unadjusted Multivariate Model A Multivariate Model B Diabetes Parameters OR (95% CI) OR (95% CI) OR (95% CI) Self reported history of DM 2.44 (1.84-3.25) 1.76 (1.33-2.32) 1.76 (1.33-2.32) Insulin use 3.31 (2.02-5.45) 2.25 (1.23-3.97) 2.35 (1.29-4.27) Oral hypoglycemic use 1.03 (0.54-1.95) 1.04 (0.54-2.02) 1.01 (0.52-1.98) Retinopathy 1.56 (0.71-3.41) 1.51 (0.69-3.33) 1.69 (0.76-3.74) Fasting plasma glucose (mg/dL) Normal (< 100) 1.00 (referent) – – Prediabetic (100-126) 1.28 (0.95-1.72) 0.88 (0.66-1.18) 0.87 (0.65-1.16) Diabetic (> 126) 2.29 (1.68-3.12) 1.28 (0.93-1.76) 1.30 (0.95-1.78) Fasting plasma insulin (uU/ml) 1.14 (1.05-1.23) 1.07 (1.01-1.14) 1.07 (1.01-1.13) HbA1c (%) Normal (< 5.7) 1.00 (referent) – – Prediabetic (5.7-6.5) 1.68 (1.17-2.42) 1.33 (0.94-1.89) 1.34 (0.94-1.90) Diabetic (> 6.5) 2.82 (1.98-4.02) 2.02 (1.41-2.89) 2.03 (1.43-2.87) HOMA-IR (FPI*FPG/405) 1.43 (1.15-1.80) 1.19 (0.97-1.46) 1.19 (0.97-1.45) Model A: Adjusted for patient factors; age, gender, race, smoking history, BMI Model B: Adjusted for patients factors in Model A as well as serum measures of creatinine, calcium, uric acid. For continuous variables: the OR for Fasting Insulin and HOMA-IR is calculated per 10-unit change. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e27-e28 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aviva Weinberg Stanford, CA More articles by this author Chirag Patel Stanford, CA More articles by this author Glenn Chertow Stanford, CA More articles by this author John Leppert Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...