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Increased Risk of Urinary Tract Calculi Among Patients With Diabetes Mellitus—A Population-based Cohort Study

  • Hsin-Shui Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, China Medical University, Bei-Gang Hospital, Yun-Lin, Taiwan
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  • Li-Ting Su
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
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  • Shinn-Zong Lin
    Affiliations
    Department of Physical Medicine and Rehabilitation, China Medical University, Bei-Gang Hospital, Yun-Lin, Taiwan

    Institute of Immunology, China Medical University Hospital, Taichung, Taiwan
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  • Fung-Chang Sung
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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  • Ming-Chung Ko
    Correspondence
    Reprint requests: Ming-Chung Ko, M.D., M.Sc., Department of Surgery, Taipei City Hospital, 145 Zheng Zhou Road, Taipei, Taiwan 103
    Affiliations
    Department of Surgery, Taipei City Hospital, Taipei, Taiwan
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  • Chung-Yi Li
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Published:November 25, 2011DOI:https://doi.org/10.1016/j.urology.2011.07.1431

      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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      References

        • Stamatelou K.K.
        • Francis M.E.
        • Jones C.A.
        • et al.
        Time trends in reported prevalence of kidney stones in the United States: 1976-1994.
        Kidney Int. 2003; 63: 1817-1823
        • Lingeman J.E.
        • Saywell Jr., R.M.
        • Woods J.R.
        • et al.
        Cost analysis of extracorporeal shock wave lithotripsy relative to other surgical and nonsurgical treatment alternatives for urolithiasis.
        Med Care. 1986; 24: 1151-1160
        • Saucier N.A.
        • Sinha M.K.
        • Liang K.V.
        • et al.
        Risk factors for CKD in persons with kidney stones: a case-control study in Olmsted County, Minnesota.
        Am J Kidney Dis. 2010; 55: 61-68
        • Wild S.
        • Roglic G.
        • Green A.
        • et al.
        Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030.
        Diabetes Care. 2004; 27: 1047-1053
        • Chan J.C.
        • Malik V.
        • Jia W.
        • et al.
        Diabetes in Asia: epidemiology, risk factors, and pathophysiology.
        JAMA. 2009; 301: 2129-2140
        • Stapleton A.
        Urinary tract infections in patients with diabetes.
        Am J Med. 2002; 113: 80S-84S
        • Chen H.F.
        • Li C.Y.
        Effect-modifications by age and sex on the risks of coronary artery disease and revascularization procedures in relation to diabetes.
        Diabetes Res Clin Pract. 2007; 75: 88-95
        • Beck-Nielsen H.
        • Groop L.C.
        Metabolic and genetic characterization of prediabetic states.
        J Clin Invest. 1994; 94: 1714-1721
        • Sakhaee K.
        • Adams-Huet B.
        • Moe O.W.
        • et al.
        Pathophysiologic basis for normouricosuric uric acid nephrolithiasis.
        Kidney Int. 2002; 62: 971-979
        • Pak C.Y.
        • Sakhaee K.
        • Moe O.
        • et al.
        Biochemical profile of stone-forming patients with diabetes mellitus.
        Urology. 2003; 61: 523-527
        • Coe F.L.
        • Parks J.H.
        • Asplin J.R.
        The pathogenesis and treatment of kidney stones.
        N Engl J Med. 1992; 327: 1141-1152
        • Muller L.M.
        • Gorter K.J.
        • Hak E.
        • et al.
        Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus.
        Clin Infect Dis. 2005; 41: 281-288
        • Abrahams H.M.
        • Stoller M.L.
        Infection and urinary stones.
        Curr Opin Urol. 2003; 13: 63-67
        • Meydan N.
        • Barutca S.
        • Caliskan S.
        • et al.
        Urinary stone disease in diabetes mellitus.
        Scand J Urol Nephrol. 2003; 37: 64-70
        • Taylor E.N.
        • Stampfer M.J.
        • Curhan G.C.
        Diabetes mellitus and the risk of nephrolithiasis.
        Kidney Int. 2005; 68: 1230-1235
        • Lieske J.C.
        • de la Vega L.S.
        • Gettman M.T.
        • et al.
        Diabetes mellitus and the risk of urinary tract stones: a population-based case-control study.
        Am J Kidney Dis. 2006; 48: 897-904
        • Lu J.F.R.
        • Hsiao W.C.
        Does universal health insurance make health care unaffordable?.
        Health Aff. 2003; 22: 77-88
        • Chen H.F.
        • Ho C.A.
        • Li C.Y.
        Increased risks of hip fracture in diabetic patients of Taiwan: a population-based study.
        Diabetes Care. 2008; 31: 75-80
        • Directorate-General Budget, Accounting and Statistics
        National Statistics of Regional Standard Classification Data.
        Directorate-General Budget, Accounting and Statistics, Taipei, Taiwan1993
        • Hoepelman I.M.
        Urinary tract infection in patients with diabetes mellitus.
        Int J Antimicrob Agents. 1994; 4: 113-116
        • Geerlings S.E.
        • Brouwer E.C.
        • Gaastra W.
        • et al.
        Effect of glucose and pH on uropathogenic and non-uropathogenic Escherichia coli: studies with urine from diabetic and non-diabetic individuals.
        J Med Microbiol. 1999; 48: 535-539
        • Hosking D.J.
        • Bennett T.
        • Hampton J.R.
        Diabetic autonomic neuropathy.
        Diabetes Care. 1978; 27: 1043-1054
        • Siener R.
        • Ebert D.
        • Hesse A.
        Urinary oxalate excretion in female calcium oxalate stone formers with and without a history of recurrent urinary tract infections.
        Urol Res. 2001; 29: 245-248
        • Zhanel G.G.
        • Harding G.K.
        • Nicolle L.E.
        Asymptomatic bacteriuria in patients with diabetes mellitus.
        Rev Infect Dis. 1991; 13: 150-154
        • Lin C.C.
        • Lai M.S.
        • Syu C.Y.
        • et al.
        Accuracy of diabetes diagnosis in health insurance claims data in Taiwan.
        J Formos Med Assoc. 2005; 104: 157-163
        • Chuang L.M.
        • Tsai S.T.
        • Huang B.Y.
        • et al.
        The current state of diabetes management in Taiwan.
        Diabetes Res Clin Pract. 2001; 54: S55-S65
        • Chou Y.H.
        • Li C.C.
        • Wu W.J.
        • et al.
        Urinary stone analysis of 1,000 patients in southern Taiwan.
        Kaohsiung J Med Sci. 2007; 23: 63-66
        • Lin F.S.
        • Wang S.S.
        • Mah Y.H.
        • et al.
        [Clinical and epidemiological studies on urolithiasis in Ilan].
        J Formos Med Assoc. 1994; 93: S142-S148
        • Oksuzyan A.
        • Juel K.
        • Vaupel J.W.
        • et al.
        Men: good health and high mortality.
        Aging Clin Exp Res. 2008; 20: 91-102

      Linked Article

      • Editorial Comment
        UrologyVol. 79Issue 1
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          Diabetes 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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