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Predictive Factors for Kidney Stone Recurrence in Type 2 Diabetes Mellitus

  • Phornphen Prasanchaimontri
    Affiliations
    Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Department of Surgery, Ratchaburi Hospital, Ratchaburi, Thailand
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  • Manoj Monga
    Correspondence
    Address correspondence to: Manoj Monga, MD, FACS, FRCS (Glasgow), Department of Urology, University of California, 200 W. Arbor Drive, MC8897, San Diego, CA 92103-8897.
    Affiliations
    Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Department of Urology, UCSD, San Diego, CA
    Search for articles by this author

      Abstract

      Objective

      To determine the predictive factors for kidney stone recurrence in type 2 diabetic patients.

      Methods

      A retrospective cohort study was conducted from 2013 to 2019 by using the database of diabetic patients diagnosed with kidney stone disease. The patients were divided into 2 groups according to stone disease status: recurrent stone and nonrecurrent stone. Baseline characteristics were compared and logistic regression was done to assess which variables could predict a stone recurrence.

      Results

      There were 1617 type 2 diabetic patients with kidney stone disease, 1244 (77%) did not have a stone recurrence and 373 (23%) had a stone recurrence. Of these patients with recurrent stone, 40% had asymptomatic stones, 43% visited emergency department, and 45% required a surgical intervention. Median time to recurrence was 64 months. Multivariable analysis revealed that body mass index (odds ratios [OR] 1.032, 95% confidence interval [CI] 1.016-1.047), urine pH (OR 0.500, CI 0.043-0.581), HbA1c (OR 1.186, CI 1.012-1.277), diabetic neuropathy (OR 1.839, CI 1.413-2.392), diabetic retinopathy (OR 1.690, CI 1.122-2.546), insulin as well as potassium citrate therapy (OR 0.611, CI 0.426-0.87), and stone with calcium oxalate and uric acid composition (OR 1.955, CI 1.420-2.691 and OR 2.221, CI 1.249-3.949, respectively) are significant predictors for stone recurrence.

      Conclusion

      The severity of diabetes and stone composition are strong predictors for stone recurrence in type 2 diabetic patients, while HbA1c and urine pH are important modifiable factors.
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