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Urology
Original research
Does chronic hyperglycaemia increase the risk of kidney stone disease? results from a systematic review and meta-analysis
  1. Robert Geraghty1,
  2. Abdihakim Abdi2,
  3. Bhaskar Somani3,
  4. Paul Cook4,
  5. Paul Roderick5
  1. 1Urology, Freeman Hospital, Newcastle upon Tyne, UK
  2. 2University of Southampton, Southampton, Hampshire, UK
  3. 3Urology, University Hospital Southampton NHS Trust, Southampton, UK
  4. 4Clinical Biochemistry, University Hospital Southampton, Southampton, Hampshire, UK
  5. 5Health Care Research Unit, University of Southampton, Southampton, UK
  1. Correspondence to Dr Robert Geraghty; rob.geraghty{at}newcastle.ac.uk

Abstract

Design Systematic review and meta-analysis of observational studies was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies reporting on diabetes mellitus (DM) or metabolic syndrome (MetS) and kidney stone disease (KSD).

Objective To examine the association between chronic hyperglycaemia, in the form of DM and impaired glucose tolerance (IGT) in the context of MetS and KSD.

Setting Population-based observational studies. Databases searched: Ovid MEDLINE without revisions (1996 to June 2018), Cochrane Library (2018), CINAHL (1990 to June 2018), ClinicalTrials.gov, Google Scholar and individual journals including the Journal of Urology, European Urology and Kidney International.

Participants Patients with and without chronic hyperglycaemic states (DM and MetS).

Main outcome measures English language articles from January 2001 to June 2018 reporting on observational studies. Exclusions: No comparator group or fewer than 100 patients. Unadjusted values were used for meta-analysis, with further meta-regression presented as adjusted values. Bias was assessed using Newcastle-Ottawa scale.

Results 2340 articles were screened with 13 studies included for meta-analysis, 7 DM (three cohort) and 6 MetS. Five of the MetS studies provided data on IGT alone. These included: DM, n=28 329; MetS, n=31 767; IGT, n=12 770. Controls: DM, n=5 89 791; MetS, n=1 78 050; IGT, n=2 93 852 patients. Adjusted risk for DM cohort studies, RR=1.23 (0.94 to 1.51) (p<0.001). Adjusted ORs for: DM cross-sectional/case-control studies, OR=1.32 (1.21 to 1.43) (p<0.001); IGT, OR=1.26 (0.92 to 1.58) (p<0.0001) and MetS, OR=1.35 (1.16 to 1.54) (p<0.0001). There was no significant difference between IGT and DM (cross-sectional/case-control), nor IGT and MetS. There was a moderate risk of publication bias. Statistical heterogeneity remained significant in adjusted DM cohort values and adjusted IGT (cross-sectional/case-control), but non-signficant for adjusted DM (cross-sectional/case-control).

Conclusion Chronic hyperglycaemia increases the risk of developing kidney stone disease. In the context of the diabetes pandemic, this will increase the burden of stone related morbidity and mortality.

PROSPERO registration number CRD42018093382

  • urolithiasis
  • diabetes & endocrinology
  • other metabolic, e.g. iron, porphyria
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-032094

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    Footnotes

    • Twitter @RobertGeraght16, @endouro

    • Contributors RG performed the search, statistical analysis and wrote the manuscript. AA performed the search and reviewed the manuscript. PC, BS and PR edited the manuscript and critiqued the statistical analysis. BS and PR decided whether or not to include studies as the senior authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request.