Correlates of kidney stone disease differ by race in a multi-ethnic middle-aged population: The ARIC study

Abstract

Objective

To identify correlates of kidney stone disease in white and African American men and women in a population-based longitudinal study starting in four US communities, and to assess differences in correlates across racial groups.

Methods

Between 1993 and 1995, 12,161 middle-aged participants of the ARIC Study provided information on history of kidney stone disease. Information on incident kidney stone-related hospitalizations was obtained from ICD codes on hospital discharge records.

Results

Kidney stone disease was reported by 12.0% of men and 4.8% of women. After multivariable adjustment, prevalent kidney stone disease was significantly (p < 0.05) associated with male gender (PR = 2.50), increased serum triglycerides (PR = 1.07 per SD increase), diabetes (PR = 1.27), gallstone disease (PR = 1.54), white race (PR = 1.67), and region of residence. Male gender (HR = 1.70), diabetes (HR = 1.98), and hypertension (HR = 1.69) were significantly associated (p < 0.05) with incident kidney stone-related hospitalizations (n = 94). Race-stratified analyses showed stronger associations of prevalent kidney stone disease with increased triglycerides, older age, and gallstone disease in African Americans compared to whites, whereas male gender showed stronger association in whites (all p-interaction < 0.05).

Conclusion

We identified novel correlates of kidney stone disease (triglycerides, gallstone disease) and risk factor interactions by race (age, male gender, triglycerides, gallstone disease).

Introduction

In the US, lifetime risk for kidney stone formation exceeds 12% in males and 6% in females (Johnson et al., 1979, Stamatelou et al., 2003, Gillen et al., 2005b). Increasing prevalence of kidney stones over time has partly been attributed to the increasing prevalence of obesity and type 2 diabetes (Stamatelou et al., 2003, Taylor et al., 2005a, Taylor et al., 2005b; Stamatelou et al., 2003, Taylor et al., 2005a, Taylor et al., 2005b). The high prevalence of kidney stones and recurrence rates of 30–40% (Coe et al., 1977) resulted in annual costs of 2 billion dollars in the US in 2000.

Known risk factors for kidney stones include diabetes (Taylor et al., 2005a, Daudon et al., 2006) and other cardiovascular disease risk factors such as hypertension, hypercholesterolemia and excess weight (Taylor et al., 2005b, Ramey et al., 2004). Individual components of the metabolic syndrome may be independent risk factors for kidney stone disease, and recent evidence suggests that it may be a systemic disorder (Ramey et al., 2004, West et al., 2008, Sakhaee, 2008). Dietary factors are also known to influence risk of stone formation (Curhan et al., 1993, Siener, 2006). Known hereditary syndromes and recent population-based studies additionally support a genetic component to kidney stone disease (Thorleifsson et al., 2009). Men and individuals of white race seem to be at a higher risk for kidney stone disease than women and African Americans, respectively (Stamatelou et al., 2003, Gillen et al., 2005b, Daudon et al., 2006, Ramey et al., 2004, Borghi et al., 1999, Curhan et al., 2005, Gillen et al., 2005a, Hiatt et al., 1982, Siener et al., 2004, Soucie et al., 1996), but many previous studies have focused on only one ethnic group or gender.

We aimed to identify correlates of a history of kidney stone disease in a cohort study among 9,541 white and 2,620 African American middle-aged participants of the Atherosclerosis Risk in Communities (ARIC) Study, and to assess the importance of these correlates across races and both cross-sectionally and prospectively.