Outpatient Antibiotic Use is Not Associated with an Increased Risk of First-Time Symptomatic Kidney Stones

Author:

Thongprayoon Charat1ORCID,Vaughan Lisa E.2,Barreto Erin F.3,Mehta Ramila A.2ORCID,Koo Kevin4,Schulte Phillip J.2,Lieske John C.15ORCID,Rule Andrew D.1ORCID

Affiliation:

1. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota

2. Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota

3. Department of Pharmacy, Mayo Clinic, Rochester, Minnesota

4. Department of Urology, Mayo Clinic, Rochester, Minnesota

5. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota

Abstract

Significance Statement Antibiotics modify human microbiomes and may contribute to kidney stone risk. In a population-based case-control study using 1247 chart-validated first-time symptomatic kidney stone formers and 4024 age- and sex-matched controls, the risk of kidney stones was transiently higher during the first year after antibiotic use. However, this risk was no longer evident after adjustment for comorbidities and excluding participants with prior urinary symptoms. Findings were consistent across antibiotic classes and the number of antibiotic courses received. This suggests that antibiotics are not important risk factors of kidney stones. Rather, kidney stones when they initially cause urinary symptoms are under-recognized, resulting in antibiotic use before a formal diagnosis of kidney stones (i.e., reverse causality). Background Antibiotics modify gastrointestinal and urinary microbiomes, which may contribute to kidney stone formation. This study examined whether an increased risk of a first-time symptomatic kidney stone episode follows antibiotic use. Methods A population-based case-control study surveyed 1247 chart-validated first-time symptomatic kidney stone formers with a documented obstructing or passed stone (cases) in Olmsted County, Minnesota, from 2008 to 2013 and 4024 age- and sex-matched controls. All prescriptions for outpatient oral antibiotic use within 5 years before the onset of symptomatic stone for the cases and their matched controls were identified. Conditional logistic regression estimated the odds ratio (OR) of a first-time symptomatic kidney stone across time after antibiotic use. Analyses were also performed after excluding cases and controls with prior urinary tract infection or hematuria because urinary symptoms resulting in antibiotic prescription could have been warranted because of undiagnosed kidney stones. Results The risk of a symptomatic kidney stone was only increased during the 1-year period after antibiotic use (unadjusted OR, 1.31; P = 0.001), and this risk was attenuated after adjustment for comorbidities (OR, 1.16; P = 0.08). After excluding cases and controls with prior urinary symptoms, there was no increased risk of a symptomatic kidney stone during the 1-year period after antibiotic use (unadjusted OR, 1.04; P = 0.70). Findings were consistent across antibiotic classes and the number of antibiotic courses received. Conclusions The increased risk of a first-time symptomatic kidney stone with antibiotic use seems largely due to both comorbidities and prescription of antibiotics for urinary symptoms. Under-recognition of kidney stones that initially cause urinary symptoms resulting in antibiotic use may explain much of the perceived stone risk with antibiotics (i.e., reverse causality).

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Nephrology,General Medicine

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Effects of Medications on the in vitro Growth of Gut Bacteria Associated With Kidney Stones;Kidney International Reports;2024-05

2. Pathophysiology and management of enteric hyperoxaluria;Clinics and Research in Hepatology and Gastroenterology;2024-05

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