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Hypertension is associated with increased urinary calcium excretion in patients with nephrolithiasis
Brian H Eisner1, Sima P Porten, Seth K Bechis
1Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. beisner@partners.org
Insights
Hypertension in kidney stone patients is linked to higher urine calcium levels. This finding suggests tailored treatments for hypertensive individuals with nephrolithiasis.
Area of Science:
- Nephrology
- Urology
- Cardiovascular Medicine
Background:
- Nephrolithiasis (kidney stones) and hypertension (high blood pressure) share known epidemiological links.
- Patients with hypertension have an increased risk of developing kidney stones, and vice versa.
- Urinary calcium and citrate levels are potential factors connecting these two conditions.
Purpose of the Study:
- To investigate the relationship between hypertension and 24-hour urine composition in patients diagnosed with nephrolithiasis.
- To determine if urinary calcium or citrate excretion is associated with hypertension in stone-forming patients.
Main Methods:
- Retrospective analysis of data from 462 patients with a history of kidney stones.
- Multivariate linear regression models adjusted for demographic and clinical factors.
- Nominal logistic regression to assess hypertension prevalence across different quintiles of calcium and citrate excretion.
Main Results:
- Hypertensive stone formers exhibited significantly higher daily urine calcium excretion (25.6 mg/day, a 12% increase) compared to normotensive individuals.
- A higher quintile of urinary calcium excretion was significantly associated with an increased relative risk of hypertension (RR 1.29).
- Urinary citrate excretion was not significantly associated with hypertension prevalence in this cohort.
Conclusions:
- In patients with nephrolithiasis, hypertension is specifically associated with elevated urinary calcium excretion.
- This association highlights the need for individualized dietary and medical management strategies for hypertensive patients with kidney stones.
Purpose:
The epidemiological relationship between nephrolithiasis and hypertension is well-known. Patients with hypertension are at increased risk for nephrolithiasis and those with nephrolithiasis are at risk for hypertension. Urine calcium or urine citrate may be related to hypertension status. We examined the relationship between hypertension and 24-hour urine composition in patients with nephrolithiasis.
Materials And Methods:
We retrospectively reviewed the database on 462 stone forming patients to examine the relationship between hypertension and 24-hour urine composition. Multivariate linear regression models were adjusted for age, race, gender, body mass index, diabetes mellitus and 24-hour urine constituents. Nominal logistic regression was also done to examine the hypertension prevalence by quintile of calcium and citrate excretion.
Results:
On adjusted multivariate analysis compared with normotensive stone formers those with hypertension excreted 25.6 mg per day more urine calcium, corresponding to a 12% increase in urinary calcium excretion. The relative risk of hypertension was significantly associated with quintile of calcium excretion but not with quintile of citrate excretion (1.29, 95% CI 1.02 to 1.61 vs 0.94, 95% CI 0.78 to 1.14).
Conclusions:
In stone formers hypertension was associated only with significantly increased urine calcium. This association is important when treating patients with nephrolithiasis since those with hypertension may require unique dietary and medical therapy.
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