MP90-01 SUCCESSFUL DIABETIC CONTROL AS MEASURED BY HEMOGLOBIN A1C DECREASES URINE RISK FACTORS FOR URIC ACID CALCULI

Abstract

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy1 Apr 2017MP90-01 SUCCESSFUL DIABETIC CONTROL AS MEASURED BY HEMOGLOBIN A1C DECREASES URINE RISK FACTORS FOR URIC ACID CALCULI Kimberly A Maciolek, Kristina L Penniston, and Sara L Best Kimberly A MaciolekKimberly A Maciolek More articles by this author , Kristina L PennistonKristina L Penniston More articles by this author , and Sara L BestSara L Best More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2820AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with diabetes mellitus (DM) have lower urine pH and a higher prevalence of uric acid calculi. It is unknown if glycemic control by patients with DM improves urinary risk factors for stones. We examined the association of hemoglobin A1c (HgbA1c), a measure of long-term DM control, with 24hr urine risk factors for uric acid and calcium calculi. METHODS With IRB approval, we identified 278 stone formers (SF) with 24h urine collections and HgbA1c measures obtained within 3 months of the urine collection. Relative saturation indices (RS) were calculated using EQUIL2. Patients were separated by glycemic status: normoglycemic (NG, HgbA1c<6.5) and hyperglycemic (HG, HgbA1c≥6.5); 24-h urine parameters were compared. The NG cohort was further divided into those with no history of DM and those with well controlled DM, characterized by HgbA1c<6.5 near the time of their 24-h urine collection. Variables were analyzed using chi squared, Welch′s t-test and multivariate linear regression to adjust for BMI, age, gender, and for thiazide and/or potassium citrate use. RESULTS Patients in the HG group were older (63 vs 60, p<0.01) and had higher BMI (35.1 vs 31.5, p<0.01). Multivariate analysis revealed that, overall, hyperglycemia was associated with lower pH (5.85 vs 6.30, p<0.001), higher uric acid RS (1.39 vs 0.69, p<0.001), and lower brushite RS (0.85 vs 1.60, p<0.001). SFs with history of DM who were well controlled had similar risk factors for uric acid stone to SFs with no history of DM (pH 6.2 vs 6.4, p=0.50, and uric acid RS 0.87 vs 0.56, p=0.85). Patients with a history of DM had a higher median urine calcium (223 mg/d vs 160, p=0.05) and corresponding higher calcium oxalate RS (1.90 vs 1.46, p=0.02) than SFs with normal HgbA1c. CONCLUSIONS Our study suggests that successful glycemic control may be associated with reduced urinary risk factors for uric acid stone formation. With good glycemic control, patients with DM had equivalent uric acid risk factors to those with no DM history and a subclinical increase in urinary risk factors for calcium stones. Our findings support promoting glycemic control as a component of the multidisciplinary medical management of stone disease. This provides us with the direction needed to reveal whether glycemic control reduces stone risk factors. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1210 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kimberly A Maciolek More articles by this author Kristina L Penniston More articles by this author Sara L Best More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...