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Original Investigation

Association Between Metabolic Syndrome and the Presence of


Kidney Stones in a Screened Population
In Gab Jeong, MD, PhD,
1
Taejin Kang, MD,
1
Jeong Kyoon Bang, MD,
1
Junsoo Park, MD,
1
Wansuk Kim, MD,
1
Seung Sik Hwang, MD, PhD,
2
Hong Kyu Kim, MD, PhD,
3
and Hyung Keun Park, MD, PhD
1
Background: Components of metabolic syndrome have been associated with kidney stone disease, but
little evidence is available to support a relationship between metabolic syndrome and kidney stone develop-
ment in healthy large screened populations.
Study Design: Cross-sectional analysis.
Setting & Participants: Data were obtained from 34,895 individuals who underwent general health
screening tests between January 2006 and December 2006 at the Asan Medical Center.
Predictor: Metabolic syndrome was dened according to criteria established by the National Cholesterol
Education Program Adult Treatment Panel III, American Heart Association, and National Heart, Lung, and
Blood Institute.
Outcomes & Measurements: The presence of kidney stones was evaluated using computed tomography
or ultrasonography.
Results: Of all those screened, 839 (2.4%) had radiologic evidence of kidney stones and metabolic
syndrome was diagnosed in 4,779 (13.7%). The multivariable-adjusted ORfor kidney stones increased with an
increasing quintile of waist circumference and systolic/diastolic blood pressure (P 0.001). Age, sex,
hypertension, and metabolic syndrome status were independent risk factors for kidney stones. The presence of
metabolic syndrome had an OR of 1.25 (95% CI, 1.03-1.50) for kidney stone prevalence. In participants with
hypertension, the OR for the presence of kidney stones was 1.47 (95% CI, 1.25-1.71) compared with that for
participants without hypertension after adjustment for other variables.
Limitations: Cross-sectional design, absence of stone composition.
Conclusion: Metabolic syndrome is associated with a signicantly increased risk of kidney stone develop-
ment. Our ndings suggest the need for interventional studies to test the effects of preventing and treating
metabolic syndrome on the risk of kidney stone development.
Am J Kidney Dis. 58(3):383-388. 2011 by the National Kidney Foundation, Inc.
INDEX WORDS: Kidney calculi; metabolic syndrome X; mass screening.
M
etabolic syndrome, the simultaneous occur-
rence of hyperglycemia, hyperlipidemia, hy-
pertension, and visceral obesity, is a chronic disease
associated with high mortality. In addition, this condi-
tion substantially increases the risk of developing
cardiovascular diseases and type 2 diabetes.
1
In the
United States, the prevalence of metabolic syndrome
is 24% in men and 23.4% in women, increasing at
ages 60-69 years to 43.5% in both sexes.
2
In Korea,
19.9% of men and 23.7% of women meet the meta-
bolic syndrome criteria established by the National
Cholesterol Education ProgramAdult Treatment Panel
III (NCEPATP III).
3
Kidney stone disease is common throughout the
world, with a lifetime cumulative incidence of symp-
tomatic nephrolithiasis ranging from 5%-10%.
4
The
prevalence of kidney stones has increased in recent
years. In American adults, the lifetime occurrence of
kidney stones increased signicantly by 37% in 1976-
1980 and again in 1988-1994.
4
Concurrent with the
westernization of Asian culture, kidney stone forma-
tion has increased recently in Asian countries.
5
The
origin of kidney stones is multifactorial, with epide-
miologic studies showing that male sex, race/ethnic-
ity, age, climate, occupation, and obesity are associ-
ated with kidney stone formation.
6,7
Obesity and components of metabolic syndrome
have been associated with nephrolithiasis,
7-12
and
several studies have suggested that metabolic syn-
drome is linked directly to the formation of kidney
stones.
13-15
Although the exact pathophysiologic
mechanisms underlying the association between met-
abolic syndrome and nephrolithiasis are unclear, met-
Fromthe
1
Department of Urology, Asan Medical Center, Univer-
sity of Ulsan College of Medicine, Seoul;
2
Department of Social
and Preventive Medicine, Inha University School of Medicine,
Incheon; and
3
Health Screening and Promotion Center, Asan
Medical Center, University of Ulsan College of Medicine, Seoul,
Korea.
Received August 27, 2010. Accepted in revised form March 22,
2011. Originally published online May 27, 2011.
Address correspondence to Hyung Keun Park, MD, PhD, Depart-
ment of Urology, Asan Medical Center, 388-1 Pungnap 2 dong,
Songpa-gu, Seoul 138-736, Korea. E-mail: hkpark@amc.seoul.kr
2011 by the National Kidney Foundation, Inc.
0272-6386/$36.00
doi:10.1053/j.ajkd.2011.03.021
Am J Kidney Dis. 2011;58(3):383-388 383
abolic syndrome has been associated with changes in
urinary constituents, including lower urinary pH, de-
creased citrate excretion, and increased uric acid and
calcium excretion, leading to increased risks of uric
acid and calcium stone formation.
13,16,17
To date, little evidence has been available to sup-
port a relationship between metabolic syndrome and
kidney stone development in healthy screened popula-
tions. Preventative health care intervention may be
improved by studying the relationship between meta-
bolic syndrome and kidney stone formation in a
screened population. Determining common modi-
able risk factors for the development of kidney stones
might uncover newstrategies for treatment and preven-
tion. We therefore investigated the association of
metabolic syndrome with kidney stone formation in a
large screened population.
METHODS
Study Participants
We retrospectively analyzed medical records of 34,895 individu-
als who visited the Health Promotion Center of the Asan Medical
Center for routine health checkups between January 2006 and
December 2006. Our health screening program includes anthropo-
metric measurements (height, weight, and waist circumference),
blood tests (complete blood cell count, basic chemistry, serologic
tests, blood coagulation test, thyroid function tests, and assays for
tumor markers), stool/urine analyses, abdominal ultrasonography
and/or computed tomography (CT), gastroberscopy, chest radiog-
raphy, pulmonary function tests, and electrocardiography. The
study protocol was approved by the Institutional Review Board of
the Asan Medical Center.
Exposure Measures
Weight, waist circumference, and blood pressure were measured
after an overnight fast, and a blood sample was drawn. Plasma
fasting glucose, serum total cholesterol, high-density lipoprotein
(HDL) cholesterol, and triglycerides were measured using enzy-
matic methods with an autoanalyzer (Toshiba 200-FR; Toshiba
Medical System Co, Ltd, www.toshiba-medical.co.jp).
Metabolic syndrome was dened according to the criteria estab-
lished in 2005 by the National Cholesterol Education Program
Adult Treatment Panel III (NCEP ATP III), American Heart Asso-
ciation, and National Heart, Lung, and Blood Institute.
18
For the
criteria for metabolic syndrome, abdominal obesity was dened as
waist circumference 90 cm in men and 80 cm in women,
according to the World Health Organization Asia-Pacic obesity
criteria.
19
Metabolic syndrome was diagnosed in those who satis-
ed at least 3 of the following 5 criteria: waist circumference 80
cm in women and 90 cm in men, triglyceride concentration
150 mg/dL or undergoing treatment for hypertriglyceridemia,
HDL cholesterol concentration 40 mg/dL in men and 50
mg/dL in women or undergoing treatment for low HDL-C level,
blood pressure 130/85 mm Hg or undergoing treatment for
hypertension, and fasting plasma glucose level 100 mg/dL or
undergoing treatment for hyperglycemia.
Outcome Measures
The presence of kidney stones was the outcome of our
analysis. We retrospectively reviewed radiology records of all
participants and recorded kidney stones as present if they were
detected using abdominal ultrasonography (n 27,884; IU-22
ultrasound unit; Philips Medical Systems, www.healthcare.
philips.com) or CT (n 7,091; SOMATOM Sensation 16;
Siemens AG, www.siemens.com/entry/cc/en); stone size did not
matter and we even counted cases for which patients did not
require treatment. Ultrasonographic examinations were con-
ducted by one of several clinically experienced radiologists at
our Health Promotion Center, and an ultrasonographic diagno-
Table 1. Baseline Demographic Characteristics
Characteristics Total
No. of Metabolic Syndrome Components Present
P 0 1 2 3 4 5
Age (y) 50.0 10.4 46.7 9.9 50.7 9.9 53.0 10.1 53.9 9.9 55.6 10.2 57.4 10.9
Age category 0.001
20-39 y 5,228 (15.0) 3,142 (22.9) 1,196 (11.9) 558 (8.7) 261 (7.7) 62 (5.1) 9 (5.0)
40-49 y 11,438 (32.8) 5,178 (37.8) 3,269 (32.7) 1,815 (28.4) 857 (25.4) 284 (23.4) 35 (19.1)
50-59 y 12,263 (35.1) 4,211 (30.8) 3,787 (37.8) 2,423 (37.8) 1,323 (39.1) 458 (37.7) 61 (33.3)
60 y 5,966 (17.1) 1,169 (8.5) 1,757 (17.6) 1,611 (25.1) 940 (27.8) 411 (33.8) 78 (42.6)
Sex 0.001
Male 20,790 (59.6) 6,604 (48.2) 6,419 (64.1) 4,481 (69.9) 2,407 (71.2) 785 (64.6) 94 (51.4)
Female 14,105 (40.4) 7,096 (51.8) 3,590 (35.9) 1,926 (30.1) 974 (28.8) 430 (35.4) 89 (48.6)
Waist circumference (cm) 80.8 9.0 75.2 7.3 81.3 7.5 85.5 7.5 88.9 7.3 90.9 7.0 92.6 7.1 0.001
Triglycerides (mg/dL) 128.3 84.7 84.2 28.1 121.8 61.6 166.1 96.6 205.5 107.0 244.9 141.3 265.0 114.4 0.001
HDL cholesterol (mg/dL) 56.8 14.1 63.7 13.3 56.3 13.0 51.2 11.8 47.3 10.8 43.7 9.0 38.9 5.8 0.001
Blood pressure (mm Hg)
Systolic 117.9 15.5 109.3 10.2 119.5 14.9 125.0 15.3 128.5 15.0 132.7 16.1 135.9 16.3 0.001
Diastolic 74.3 9.5 69.2 6.9 75.3 9.1 78.6 9.1 80.7 9.3 82.7 9.2 82.8 8.7 0.001
Fasting glucose (mg/dL) 97.5 19.4 90.4 8.0 96.3 16.2 102.2 21.6 110.6 28.6 120.7 32.4 135.4 34.9 0.001
Note: Continuous variables given as mean standard deviation; categorical variables are number (percentage). Conversion factors
for units: cholesterol in mg/dL to mmol/L, 0.02586; glucose in mg/dL to mmol/L, 0.05551; triglycerides in mg/dL to mmol/L,
0.01129.
Abbreviation: HDL, high-density lipoprotein.
Am J Kidney Dis. 2011;58(3):383-388 384
Jeong et al
sis of kidney stones required demonstration of any hyperechoic
structure causing acoustic shadowing. The CT diagnosis of
kidney stones was established by visualization of a high-
attenuation structure (100 Hounseld units) in the kidney.
Statistical Analyses
We performed inter-rater reliability analysis using the statistic
to determine the agreement between CT and ultrasonography in
7,091 participants who underwent both CT and ultrasonography.
The prevalence of metabolic syndrome and individual components
thereof and the numbers of metabolic syndrome components
present (0, 1, 2, or 3) were determined for the overall study
sample. Mean values for continuous demographic and metabolic
variables were calculated relative to the presence of kidney stones.
The statistical signicance of differences among these variables
was assessed using Mann-Whitney U test and
2
test. Crude and
multivariable-adjusted odds ratios (ORs) of kidney stone presence
were calculated using logistic regression models with age, sex,
metabolic syndrome components, and metabolic syndrome status
as input factors. The best-tting model was judged according to the
Akaike information criterion (AIC), and the model with the lowest
AIC was considered to be the best-tting model. The AIC was used
to select the most parsimonious model.
20
All P values were 2
tailed, and P 0.05 was dened as statistically signicant. All
statistical analysis was performed using Stata, version 10.1 (Stata-
Corp).
RESULTS
Baseline demographic characteristics of the 34,895
participants are listed in Table 1. In the study popula-
tion, 59.6% were men and 67.9% were aged 40-59
years. As the number of metabolic syndrome compo-
nents increased, waist circumference, triglyceride con-
centration, blood pressure, and fasting blood glucose
level increased, whereas HDL cholesterol level de-
creased.
Atotal of 839 participants (2.4% of the population)
had radiologic evidence of kidney stones. Of the
7,091 participants who underwent CT and ultrasonog-
raphy, 368 (5.2%) had kidney stones detected using
CT or ultrasonography. Of the 7,091 participants who
underwent both CT and ultrasonography, was 0.78
(P 0.001), for excellent agreement (Table 2). Of
839 participants with kidney stones, a single stone
was found in 638 (76.0%); 2 stones, in 107 (12.8%); 3
stones, in 53 (6.3%); 4 stones, in 38 (4.5%); and 5
stones, in 3 participants (0.4%). Mean number of
kidney stones per person was 1.4. Mean kidney stone
size was 6.5 mm (median, 6; range, 1-27). Character-
istics of kidney stones by the number of metabolic
syndrome component fullled are listed in Table 3. As
the number of metabolic syndrome components in-
creased, the frequency of kidney stones increased
regardless of the diagnostic test used.
Overall, 4,779 (13.7%) participants were given a
diagnosis of metabolic syndrome. The criterion for
increased blood pressure was fullled in 30.5% of
participants and was the most common of the 5
metabolic syndrome components (increased triglycer-
ides, 27.2%; increased waist circumference, 24.2%;
low HDL cholesterol, 15.4%; and impaired glucose
tolerance, 13.7%). A total of 61% of participants
fullled at least one criterion of metabolic syndrome.
Table 4 lists crude and multivariable-adjusted ORs
for kidney stones according to quintile of the 5 meta-
bolic syndrome components. Crude and multivariable-
adjusted ORs for kidney stones increased with increas-
ing quintile of waist circumference (P 0.001) and
systolic and diastolic blood pressure (P 0.001 and
P 0.001, respectively). When each of the 5 meta-
Table 2. Agreement Between Diagnostic Tests for the
Detection of Kidney Stones in Participants Who Had Both
CT and US
Kidney Stone on US
Total Yes No
Kidney stone on CT
Yes 239 (3.3) 20 (0.3) 259 (3.6)
No 109 (1.6) 6,723 (94.8) 6,832 (96.4)
Total 348 (4.9) 6,743 (95.1) 7,091 (100)
Note: N 7,091. Values shown are number (percentage).
Abbreviations: CT, computed tomography; US, ultrasonogra-
phy.
Table 3. Characteristics of Kidney Stone by Number of Metabolic Syndrome Components Fullled
Characteristics Total
No. of Metabolic Syndrome Components Present
P 0 1 2 3 4 5
No. of participants 34,895 13,700 10,009 6,407 3,381 1,215 183
Presence of kidney stone by
diagnostic test
Total 839 (2.4) 240 (1.8) 245 (2.4) 177 (2.8) 131 (3.9) 38 (3.1) 8 (4.4) 0.001
Detected by US 675 (1.8) 198 (1.8) 191 (2.4) 137 (2.7) 112 (4.1) 31 (3.3) 6 (4.2) 0.001
Detected by CT 164 (1.5) 42 (1.5) 54 (2.7) 40 (3.1) 19 (3.0) 7 (2.5) 2 (5.1) 0.001
No. of kidney stones per person 1.4 0.8 1.4 0.8 1.4 0.8 1.4 0.8 1.4 0.7 1.4 1.0 1.4 0.8 0.9
Size of the largest kidney stone (mm) 6.5 3.1 6.5 3.0 6.5 2.9 6.6 3.8 6.0 2.1 5.9 2.5 6.4 2.0 0.8
Note: Categorical variables are shown as number (percentage), continuous variables as mean standard deviation.
Abbreviations: CT, computed tomography; US, ultrasonography.
Am J Kidney Dis. 2011;58(3):383-388 385
Metabolic Syndrome and Kidney Stone
bolic components was analyzed as a continuous vari-
able, systolic and diastolic blood pressure (P 0.001
and P 0.001, respectively), waist circumference
(P 0.001), and triglyceride concentration (P
0.02) were independent risk factors for kidney stones
after adjustment for age and sex. HDL cholesterol and
fasting blood glucose levels were not associated inde-
pendently with risk of kidney stones (P 0.3 and P
0.7, respectively).
Table 5 lists crude and multivariable-adjusted ORs
of kidney stone presence associated with age, sex,
hypertension, and metabolic syndrome status. We
selected this as the best-tting model because it had
the lowest AIC value. Age was signicantly positively
associated with the OR for kidney stone development.
The presence of metabolic syndrome (3 criteria)
was associated with a 71% increased OR of kidney
stone prevalence compared with the absence of meta-
bolic syndrome. After adjustment for age, sex, and the
presence of hypertension, this OR decreased to 1.25
(95% condence interval [CI], 1.03-1.50). Compared
with men, women had a multivariable OR for the
presence of kidney stones of 0.56 (95% CI, 0.48-
0.65). In participants with hypertension, the OR for
the presence of kidney stones was 1.47 (95% CI,
1.25-1.71) compared with those without hypertension
Table 4. Crude and Multivariable-Adjusted ORs for Kidney Stone by Quintile of the 5 Metabolic Syndrome Components
Total No.
Cases of Stones
No. (%)
Crude OR
(95% CI) P Adjusted OR (95% CI)
a
P
Waist circumference 0.001 0.001
Quintile 1 (72 cm) 7,024 100 (1.4) 1.00 (reference) 1.00 (reference)
Quintile 2 (73-78 cm) 7,946 142 (1.8) 1.26 (0.97-1.63) 0.98 (0.75-1.28)
Quintile 3 (79-83 cm) 7,536 185 (2.5) 1.74 (1.36-2.23) 1.13 (0.86-1.49)
Quintile 4 (84-88 cm) 5,510 178 (3.2) 2.31 (1.80-2.96) 1.42 (1.07-1.89)
Quintile 5 (89 cm) 6,879 234 (3.4) 2.44 (1.93-3.09) 1.48 (1.12-1.95)
Triglycerides 0.001 0.2
Quintile 1 (69 mg/dL) 6,994 138 (2.0) 1.00 (reference) 1.00 (reference)
Quintile 2 (70-92 mg/dL) 6,955 129 (1.9) 0.94 (0.74-1.20) 0.79 (0.62-1.01)
Quintile 3 (93-122 mg/dL) 6,991 186 (2.7) 1.36 (1.09-1.70) 1.06 (0.85-1.33)
Quintile 4 (123-170 mg/dL) 6,967 180 (2.6) 1.31 (1.05-1.65) 0.97 (0.77-1.22)
Quintile 5 (171 mg/dL) 6,988 206 (3.0) 1.51 (1.22-1.88) 1.07 (0.86-1.35)
HDL cholesterol 0.001 0.2
Quintile 1 (44 mg/dL) 7,080 212 (3.0) 1.00 (reference) 1.00 (reference)
Quintile 2 (45-51 mg/dL) 6,893 174 (2.5) 0.84 (0.69-1.03) 0.89 (0.73-1.09)
Quintile 3 (52-58 mg/dL) 6,984 169 (2.4) 0.80 (0.66-0.99) 0.90 (0.73-1.10)
Quintile 4 (59-67 mg/dL) 6,962 146 (2.1) 0.69 (0.56-0.86) 0.84 (0.68-1.04)
Quintile 5 (68 mg/dL) 6,976 138 (2.0) 0.65 (0.53-0.81) 0.88 (0.70-1.10)
Systolic BP 0.001 0.001
Quintile 1 (105 mm Hg) 7,466 113 (1.5) 1.00 (reference) 1.00 (reference)
Quintile 2 (106-113 mm Hg) 7,138 161 (2.3) 1.50 (1.18-1.91) 1.27 (0.99-1.62)
Quintile 3 (114-120 mm Hg) 6,476 148 (2.3) 1.52 (1.19-1.95) 1.19 (0.93-1.53)
Quintile 4 (121-130 mm Hg) 7,171 202 (2.8) 1.89 (1.50-2.38) 1.40 (1.10-1.78)
Quintile 5 (131 mm Hg) 6,644 215 (3.2) 2.18 (1.73-2.74) 1.58 (1.25-2.01)
Diastolic BP 0.001 0.001
Quintile 1 (66 mm Hg) 7,326 117 (1.6) 1.00 (reference) 1.00 (reference)
Quintile 2 (67-71 mm Hg) 6,888 148 (2.2) 1.35 (1.06-1.73) 1.15 (0.90-1.48)
Quintile 3 (72-76 mm Hg) 7,170 152 (2.1) 1.33 (1.05-1.70) 1.07 (0.84-1.37)
Quintile 4 (77-82 mm Hg) 6,939 189 (2.7) 1.72 (1.37-2.18) 1.31 (1.03-1.66)
Quintile 5 (83 mm Hg) 6,572 233 (3.6) 2.27 (1.81-2.84) 1.64 (1.30-2.07)
Fasting glucose 0.001 0.1
Quintile 1 (85 mg/dL) 6,992 137 (2.0) 1.00 (reference) 1.00 (reference)
Quintile 2 (86-91 mg/dL) 7,098 139 (2.0) 1.00 (0.91-1.44) 0.89 (0.70-1.13)
Quintile 3 (92-96 mg/dL) 6,973 156 (2.2) 1.15 (0.91-1.44) 0.94 (0.74-1.19)
Quintile 4 (97-103 mg/dL) 6,903 196 (2.8) 1.46 (1.17-1.82) 1.12 (0.89-1.40)
Quintile 5 (104 mg/dL) 6,929 211 (3.1) 1.57 (1.26-1.95) 1.09 (0.87-1.37)
Note: Conversion factors for units: cholesterol in mg/dL to mmol/L, 0.02586; glucose in mg/dL to mmol/L, 0.05551; triglycerides in
mg/dL to mmol/L, 0.01129.
Abbreviations: BP, blood pressure; CI, condence interval; HDL, high-density lipoprotein; OR, odds ratio.
a
Adjusted for age and sex.
Am J Kidney Dis. 2011;58(3):383-388 386
Jeong et al
after adjustment for other variables. The diagnostic
test for detecting kidney stones was not associated
signicantly with the detection of kidney stones (crude
OR, 0.94 for CT vs ultrasonography; 95% CI, 0.79-
1.12; P 0.5). After adjustment for age, sex, hyper-
tension, and the presence of metabolic syndrome,
diagnostic testing was not associated with the OR of
the presence of kidney stones (multivariable-adjusted
OR, 0.95; 95% CI, 0.80-1.12; P 0.5).
DISCUSSION
In our large screened population, metabolic syn-
drome was associated with a signicantly increased
risk of kidney stone presence after adjustment for
other confounding variables. We also showed that
metabolic syndrome is associated with risk of kidney
stones in addition to already known independent met-
abolic risk factors, such as hypertension. Our results
are consistent with those of an earlier study, which
found a signicant association between metabolic
syndrome and echographic evidence of nephrolithia-
sis in an inpatient white population referred to the
hospital for any reason.
14
However, our present study
is the rst to show such an association in a large
screened population of healthy Asian men.
Although the detailed mechanisms responsible for
the association of metabolic syndrome with kidney
stone development are unclear, the syndrome has
been associated with a self-reported history of kidney
stones. In a study of 14,870 participants in the Third
National Health and Nutrition Examination Survey
(NHANES III), the presence of 4-5 traits of metabolic
syndrome was associated with an approximately 2-fold
increase in self-reported kidney stone disease.
15
We also found that hypertension was associated
positively with risk of kidney stones after adjustment
for patient age, sex, and the presence of metabolic
syndrome. Compared with normotensive patients, the
multivariable OR for kidney stones in hypertensive
patients was 1.47. To date, several epidemiologic
studies have analyzed the association between hyper-
tension and nephrolithiasis. In cross-sectional studies,
it has been reported that nephrolithiasis is more fre-
quent in hypertensive patients than in those who are
normotensive, but the pathologic link between hyper-
tension and stone disease remains to be claried.
21-24
In addition, some prospective studies reported the risk
of stones in hypertensive patients.
10,22,25
Although previous studies have suggested that the
prevalence of kidney stones is amplied by diabetes
mellitus, especially in those with uric acid nephrolithia-
sis, our data do not support a possible association
between diabetes and kidney stones.
8,26,27
In our
study, fasting blood glucose level, which was ana-
lyzed as either a categorical or continuous variable,
was not an independent risk factor for kidney stones
after adjustment for patient age and sex. It is difcult
to directly compare our results with those of studies
conducted in Western countries. Differences in racial/
ethnic variables, age distribution, frequency of neph-
rolithiasis, methods of detection of nephrolithiasis (ie,
electronic data based or self-reported questionnaires
vs a radiologic diagnosis), and study populations may
have affected results of analyses. Therefore, addi-
Table 5. Crude and Multivariable-Adjusted ORs of the Association Between Kidney Stone Presence and Metabolic Syndrome Status
Total No.
Cases of Stones
No. (%)
Crude OR
(95% CI) P
Adjusted
OR (95% CI)
a
P
Age category
20-39 y 5,163 65 (1.2) 1.00 (reference) 1.00 (reference)
40-49 y 11,209 229 (2.0) 1.62 (1.23-2.14) 0.001 1.50 (1.14-1.98) 0.004
50-59 y 11,896 367 (3.0) 2.45 (1.88-3.20) 0.001 2.13 (1.63-2.79) 0.001
60 y 5,788 178 (2.4) 2.44 (1.83-3.25) 0.001 1.96 (1.46-2.63) 0.001
Sex
Male 20,171 619 (3.0) 1.00 (reference) 1.00 (reference)
Female 13,885 220 (1.6) 0.52 (0.44-0.60) 0.001 0.56 (0.48-0.65) 0.001
Hypertension
No 23,779 465 (1.9) 1.00 (reference) 1.00 (reference)
Yes 10,277 374 (3.5) 1.86 (1.62-2.14) 0.001 1.47 (1.25-1.71) 0.001
Metabolic syndrome
No 29,454 662 (2.2) 1.00 (reference) 1.00 (reference)
Yes 4,602 177 (3.7) 1.71 (1.45-2.03) 0.001 1.25 (1.03-1.50) 0.02
Note: Criteria for metabolic syndrome were used as dened by the National Cholesterol Education Program Adult Treatment Panel
III, American Heart Association, National Heart, Lung, and Blood Institute statement.
18
Abbreviations: CI, condence interval; OR, odds ratio.
a
Multivariable adjusted.
Am J Kidney Dis. 2011;58(3):383-388 387
Metabolic Syndrome and Kidney Stone
tional studies are needed to determine whether diabe-
tes is an independent risk factor for the formation of
calcium stones.
Our ndings have important implications for clini-
cal care and public health because metabolic syn-
drome is so common. If metabolic syndrome and the
presence of kidney stones are associated, stone devel-
opment may be prevented by lifestyle modication
and subsequent resolution of metabolic syndrome.
Our study was strengthened by the large size of the
screened cohort population and the use of standard-
ized clinical and laboratory covariates. However, the
study was limited by our inability to measure and
analyze stone composition. In addition, it was difcult
to dene the duration of any metabolic risk factor
because a substantial number of individuals with such
risk factors may be undiagnosed and the duration of
risk factors may reect the extent of medical surveil-
lance. Last, because our study was not longitudinal,
we could not determine whether a causal relationship
existed between metabolic syndrome or obesity and
kidney stone development.
In conclusion, we found that metabolic syndrome
was a strong and independent risk factor for kidney
stone formation. This association suggests that kidney
stones may be a systemic disorder representing the
interaction of multiple metabolic risk factors. These
results argue for interventional studies to examine the
effects of prevention and treatment of metabolic syn-
drome on the risk of kidney stone development.
ACKNOWLEDGEMENTS
Support: None.
Financial Disclosure: The authors declare that they have no
relevant nancial interests.
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