Kidney stones increase risk of ESRD

The risks of end-stage renal disease (ESRD), chronic kidney disease, and sustained doubling of serum creatinine concentration are significantly higher in people with at least one symptomatic kidney stone episode, according to the results of a study published August 30 in the British Medical Journal.

According to R. Todd Alexander, assistant professor at the University of Alberta in Alberta, Canada, and colleagues, kidney stones are common and potentially preventable, and therefore an accurate assessment of their potential long-term consequences would be important to inform health interventions.

The researchers sought to assess whether the presence of kidney stones would increase the risk of ESRD or other adverse renal outcomes, including the development of stage 3b–5 chronic kidney disease (estimated glomerular filtration rate <45 mL/min/1.73 m²), and sustained doubling of serum creatinine concentration from baseline.

Using the Alberta Kidney Disease Network database, the authors identified a cohort of 3,089,194 adults aged ≥18 years who resided in Alberta, Canada, between April 1997 and March 2009 and who did not have ESRD at baseline; 1,954,836 had outpatient serum creatinine measurements and were included in analyses of chronic kidney disease and doubling of serum creatinine level.

During the median follow-up period of 11 years, 23,706 (0.8%) patients developed at least one kidney stone; 5,333 (0.2%) developed ESRD. In the subset of patients with serum creatinine data, the median follow-up period was 4 years, during which 68,525 (4%) patients developed stage 3b–5 chronic kidney disease and 6,581 (0.3%) experienced sustained doubling of serum creatinine from baseline.

The authors noted that those at higher risk for all three adverse outcomes included women and those younger than aged 50 years who had at least one episode of stones. Those who had more than one episode of stones were at an even higher risk than those with a single episode.

“These findings suggest that kidney stones are an important potential contributor to the risk of ESRD and that patients with prior kidney stones should be considered at increased risk for adverse renal outcomes-especially younger women or those with multiple symptomatic episodes,” the authors noted. They concluded that further research should focus on explaining this association and assessing a way to prevent kidney stones.

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