Objective
To investigate the inter-relationship among diabetes, urinary tract infection (UTI),
and urinary tract calculi (UTC).
Methods
This study used Taiwan's National Health Insurance claims data of ambulatory care
visits and hospitalizations. A total of 12,257 newly diagnosed diabetes cases in 2000-2002
and 96,781 controls were followed to the end of 2007. The person-year approach with
Poisson assumption was used to estimate the incidence density (ID) of UTC by diabetic
status. Relative risk of UTC in relation to diabetes and UTI were estimated from Cox
proportional hazard model with adjustment for sociodemographic variables and comorbidities.
Results
Over nearly 8 years of follow-up, 8.9% of diabetes and 7.2% of control subjects sought
ambulatory care or were hospitalized for UTC, representing the ID of 14.4 and 11.4
per 1000 person-years, respectively. The multivariate analysis indicated that UTC
risk was independently associated with diabetes (hazard ratio 1.18, 95% CI 1.10-1.27)
and UTI (HR 1.68, 95% CI 1.60-1.76). The hazard ratio of UTC in relation to diabetes
in men and women without UTI was 1.24 and 1.26, respectively. Diabetes may further
increase the rate of UTC in women with UTI, with an hazard ratio increased from 1.79-2.12.
Such additive effect by diabetes in men with UTI was only marginal (HR 1.68 vs 1.67).
Conclusion
This cohort study provides epidemiologic support for the causal association between
diabetes and UTC, which is independent of UTI. In addition, female patients with UTI
accompanied by diabetes tended to be associated with a greater rate of UTC.
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Article info
Publication history
Published online: November 25, 2011
Accepted:
July 11,
2011
Received:
January 2,
2011
Footnotes
Ming-Chung Ko and Chung-Yi Li contributed equally to this article.
Funding Support: This study was supported by a contract with the Taiwan National Scientific Council (NSC98-2314-B-227-001-MY2), Department of Health (DOH100-TD-B-111-004 and DOH100-TD-C-111-005) and the China Medical University Hospital (1MS1).
The interpretation and conclusions contained herein do not represent those of BNHI, Department of Health or NHRI.
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Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Editorial CommentUrologyVol. 79Issue 1
- PreviewDiabetes mellitus has been associated with an increased risk of kidney stone formation in a number of epidemiologic studies.1-3 With the exception of a study from Turkey,2 these data reflect the findings from a population of American adults, with presumably Western trends in diet and lifestyle. The present study not only provides additional evidence for the link between diabetes mellitus and kidney stone formation but also extends it to a large, Taiwanese cohort. It also reinforces the notion that nephrolithiasis is a reflection of systemic disease—an increased incidence of stone disease is seen in patients with diabetes mellitus, as well as other common systemic conditions, such as metabolic syndrome and hypertension.
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