Kidney stones and cardiovascular events: a cohort study - PubMed (original) (raw)

Kidney stones and cardiovascular events: a cohort study

R Todd Alexander et al. Clin J Am Soc Nephrol. 2014 Mar.

Abstract

Background and objectives: Kidney stones are common in general clinical practice, and their prevalence is increasing. Kidney stone formers often have risk factors associated with atherosclerosis, but it is uncertain whether having a kidney stone is associated with higher risk of cardiovascular events. This study sought to assess the association between one or more kidney stones and the subsequent risk of cardiovascular events.

Design, setting, participants, & measurements: Cohort study of 3,195,452 people aged≥18 years registered in the universal health care system in Alberta, Canada, between 1997 and 2009 (median follow-up of 11 years). People undergoing dialysis or with a kidney transplant at baseline were excluded. The primary outcome was the first acute myocardial infarction (AMI) during follow-up. We also considered other cardiovascular events, including death due to coronary heart disease, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass grafting (CABG), and stroke.

Results: In total, 25,532 (0.8%) participants had at least one kidney stone, and 91,465 (3%) individuals had at least one cardiovascular event during follow-up. Compared with people without kidney stones and after adjustment for cardiovascular risk factors and other potential confounders, people who had at least one kidney stone had a higher risk of subsequent AMI (adjusted hazard ratio [HR], 1.40; 95% confidence interval [95% CI], 1.30 to 1.51), PTCA/CABG (HR, 1.63; 95% CI, 1.51 to 1.76), and stroke (HR, 1.26; 95% CI, 1.12 to 1.42). The magnitude of the excess risk associated with a kidney stone appeared more pronounced for younger people than for older people (P<0.001) and for women than men (P=0.01).

Conclusions: The occurrence of a kidney stone is associated with a higher risk of cardiovascular events, including AMI, PTCA/CABG, and stroke.

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Figures

Figure 1.

Figure 1.

Participant flow. AKDN, Alberta Kidney Disease Network; eGFR, estimated GFR using the CKD-Epidemiology Collaboration formula; sCr, serum creatinine.

Figure 2.

Figure 2.

Forest plots of cardiovascular events in the primary and laboratory cohorts. The plots show the relative adjusted hazards (with corresponding 95% confidence intervals) of cardiovascular events associated with first kidney stone presentation during the study follow-up. Cardiovascular events include acute myocardial infarction (AMI), coronary heart disease (CHD) death (includes angina), percutaneous transluminal coronary angioplasty (PTCA)/coronary artery bypass grafting (CABG), and stroke. The left panel shows participants in the primary cohort (_n_=3,195,452); the right panel shows participants in the laboratory cohort (_n_=2,003,054). Hazard ratios from both cohorts were adjusted for age, sex, Aboriginal status, social assistance, residence location, and comorbid conditions (diabetes, hypertension, coronary heart disease, cancer, AIDS/HIV, cerebral vascular disease, chronic obstructive pulmonary disease, dementia, heart failure, mild liver disease, moderate/severe liver disease, paraplegia, peptic ulcer, peripheral vascular disease, and rheumatologic disease). Hazard ratios from the laboratory cohort have also been adjusted for baseline eGFR and albuminuria. 95% CI, 95% confidence interval; CV, cardiovascular; HR, hazard ratio.

Figure 3.

Figure 3.

Forest plots of AMI events in the primary and laboratory cohorts, by strata. The plots show the relative adjusted hazards (with corresponding 95% confidence intervals) of AMI associated with the first kidney stone presentation during the study follow-up, overall (top square point symbol) and in subgroups. The left panel shows participants in the primary cohort (_n_=3,195,452); the right panel shows participants in the laboratory cohort (_n_=2,003,054). The P values are a measure of the interaction between each characteristic and the risk of AMI associated with the first kidney stone presentation. Hazard ratios from both cohorts were adjusted for age, sex, Aboriginal status, social assistance, residence location, and comorbid conditions (diabetes, hypertension, coronary heart disease, cancer, AIDS/HIV, cerebral vascular disease, chronic obstructive pulmonary disease, dementia, heart failure, mild liver disease, moderate/severe liver disease, paraplegia, peptic ulcer, peripheral vascular disease, and rheumatologic disease). Hazard ratios from the laboratory cohort have also been adjusted for baseline estimated GFR and albuminuria. ACR, albumin-to-creatinine ratio.

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References

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