Calcium Kidney Stones are Associated with Increased Risk of Carotid Atherosclerosis: The Link between Urinary Stone Risks, Carotid Intima-Media Thickness, and Oxidative Stress Markers.

Ho Shiang Huang,Pao Chi Liao,Chan Jung Liu

doi:10.3390/jcm9030729

Abstract

Previous studies have suggested that kidney stone formers are associated with a higher risk of cardiovascular events. To our knowledge, there have been no previous examinations of the relationship between carotid intima-media thickness (IMT) and urinary stone risk factors. This study was aimed toward an investigation of the association between dyslipidemia, IMT, and 24-hour urinalysis in patients with calcium oxalate (CaOx) or calcium phosphate (CaP) stones. We prospectively enrolled 114 patients with kidney stones and 33 controls between January 2016 and August 2016. All patients were divided into four groups, according to the stone compositions—CaOx ≥ 50% group, CaP group, struvite group, and uric acid stones group. Carotid IMT and the carotid score (CS) were evaluated using extracranial carotid artery doppler ultrasonography. The results of a multivariate analysis indicated that a higher serum total cholesterol (TC) and low-density lipoprotein (LDL) were all associated with lower urinary citrate and higher CS in both the CaOx ≥ 50% and CaP groups. Higher serum TC and LDL were also associated with increased serum 8-OHdG levels in both groups. The levels of carotid IMT and CS in the CaOx ≥ 50% and CaP groups were all significantly higher than in the controls. These findings suggest a strong link between dyslipidemia, carotid atherosclerosis, and calcium kidney stone disease.

Highlights

A complete picture of the mechanisms involved in kidney stone disease is still not available several factors and steps involved in the crystallization and stone formation in kidneys have been elucidated [1]
Ninety-four patients in the kidney stone group were within the Ca-containing stones
After adjusting by age and sex (Table 4), in the multivariate analysis, only urinary citrate levels (OR = 0.970, p = 0.003 in calcium oxalate (CaOx) ≥ 50% group; Odds ratio (OR) = 0.970, p = 0.001 in calcium phosphate (CaP) group) and carotid score (CS) (OR = 15.291, p = 0.013 in CaOx ≥ 50% group; OR = 2.964, p = 0.032 in CaP group) still had a significant association with higher serum total cholesterol (TC) in both groups

Summary

Introduction

A complete picture of the mechanisms involved in kidney stone disease is still not available several factors and steps involved in the crystallization and stone formation in kidneys have been elucidated [1]. In addition to free and fixed particle theories and the Randall plaque hypothesis of stone pathogenesis, a vascular theory of Randall plaque formation has been suggested [7]. The precise mechanisms underlying the association between kidney stone disease and CVD remain to be elucidated, one potential risk factor could be atherosclerosis, as supported by the CARDIA study [8]. Production of reactive oxygen species (ROS) and development of oxidative stress is a common feature of CVD and calcium oxalate (CaOx) stone disease [9]. The association between atherosclerosis and Ca-containing kidney stone disease requires further investigation

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