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Nephrolithiasis among Middle Aged and Elderly Urban Chinese: A Report from Prospective Cohort Studies in Shanghai: Beyond the Abstract

Obesity and chronic diseases including coronary heart disease, stroke, hypertension, and type 2 diabetes are known risk factors for kidney stones in Western populations (1-4). However, these associations have been understudied in Asian populations. In recent decades, the rapid urbanization in China has brought dramatic dietary and lifestyle changes, along with increases in the incidence of comorbid diseases, and likely kidney stone risk.  

This study was conducted to estimate kidney stone incidence in China using data of large prospective population cohorts, the Shanghai Women’s Health Study and Shanghai Men’s Health Study. Subjects included in the current study were middle-aged and elderly urban Chinese who were free of kidney stone at baseline recruitment (women, 40-70 years, N=69,166; men, 40-74 years, N=58,054). Information regarding demographics, dietary habits, physical activities, and medical history including history of diabetes, hypertension, coronary heart disease, and stroke were collected via in-person interviews at baseline. Self-reported kidney stone occurrences were recorded at the follow-up visits. 

After an average 8 years of follow-up, overall kidney stone incidence rates were 3.80 (95% CI 3.59-4.02) and 2.10 (95% CI 1.99-2.21) per 1000 person-years for men and women, respectively. Higher risk of kidney stones were observed among participants who were overweight/obese (body mass index≥25 kg/m2 or centrally obese (waist-hip-ratio>0.80 for women and >0.90 for men). History of coronary heart disease/store was related to higher kidney stone risk in women but not men, while hypertension was associated with higher risk in men only. Reasons for the observed gender disparities are not clear, but this supports growing evidence that women and men may have different risk factor profiles for kidney stones. No association was observed for history of diabetes in both genders. However, the possibility of under-diagnosis of diabetes among study participants may undermine our power to detect the associations. The findings of this study provide evidence that the association of metabolic syndrome and kidney stone disease persists across race and ethnicity.

Written by: Xiang Shu, Hui Cai, Yong-Bing Xiang, Honglan Li, Loren Lipworth, Nicole L Miller, Wei Zheng, Xiao-Ou Shu, Ryan S Hsi

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References
  1. Ferraro PM, Taylor EN, Eisner BH, et al. History of kidney stones and the risk of coronary heart disease. JAMA. 2013;310:408-415.
  2. Rule AD, Roger VL, Melton LJ, 3rd, et al. Kidney stones associate with increased risk for myocardial infarction. J Am Soc Nephrol. 2010;21:1641-1644.
  3. Madore F, Stampfer MJ, Rimm EB, Curhan GC. Nephrolithiasis and risk of hypertension. Am J Hypertens. 1998;11:46-53.
  4. Rule AD, Bergstralh EJ, Melton LJ, 3rd, Li X, Weaver AL, Lieske JC. Kidney stones and the risk for chronic kidney disease. Clinical journal of the American Society of Nephrology: CJASN. 2009;4:8