Factors associated with sex differences in the risk of kidney stones

Author:

Ferraro Pietro Manuel12ORCID,Taylor Eric N34,Curhan Gary C3

Affiliation:

1. U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy

2. Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore , Rome, Italy

3. Renal Division and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA

4. Section of Nephrology, VA Maine Healthcare System , Augusta, ME, USA

Abstract

ABSTRACTBackgroundMen are at higher risk of developing stones compared with women; however, recent data suggest a changing epidemiology, with women being relatively more affected than before.MethodsTo estimate the proportion of excess risk among men, we analysed data from large cohorts (Health Professionals Follow-up Study and Nurses’ Health Study I and II). Kidney stone incidence rates were computed and hazard ratios (HRs) and 95% confidence intervals (CIs) generated with age-adjusted Cox proportional regression models. Mediation analysis estimated the excess risk for men explained by risk factors, including waist circumference, high blood pressure, diabetes, use of thiazides and dietary intake. The 24-h urine composition was also examined.ResultsThe analysis included 268 553 participants, contributing 5 872 249 person-years of follow-up. A total of 10 302 incident stones were confirmed and the overall incidence rate was 271 and 159 per 100 000 person-years for men and women, respectively. The age-adjusted HR was 2.32 (95% CI 2.20, 2.45) and the risk of stones was consistently higher across categories of age (HRs ranging from 2.02 to 2.76) for men compared with women. The risk remained higher among men, but tended to decrease over time (48.1%), while it increased among women. Urine supersaturations for calcium oxalate and uric acid were higher among men, primarily because of higher oxalate (26.3%), uric acid (16.3%), phosphate (23.5%) and lower pH.ConclusionsThe risk of kidney stones is higher among men and this difference is only partly explained by lifestyle risk factors; differences in urine chemistries explain a substantial fraction of the excess risk.

Funder

NIH

European Reference Network for Rare Kidney Diseases

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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