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Associations between Net Gastrointestinal Alkali Absorption, 24-Hour Urine Lithogenic Factors, and Kidney Stones
Pietro Manuel Ferraro1,2, Eric N Taylor3,4, John R Asplin5
1U.O.S. Terapia Conservativa della Malattia Renale Cronica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Summary
Kidney stone formers exhibit reduced net gastrointestinal alkali absorption, impacting urine composition and increasing stone formation risk. This finding highlights a key factor in understanding kidney stone development.
Area of Science:
- Nephrology
- Gastroenterology
- Metabolic Disorders
Background:
- The gut's role in handling alkali and acid precursors and its impact on urine composition and kidney stone formation remain unclear.
- Investigating the determinants of net gastrointestinal alkali absorption is crucial for understanding kidney stone etiology.
Purpose of the Study:
- To investigate the determinants of net gastrointestinal alkali absorption (NGIAA).
- To examine the association between NGIAA, urinary parameters, and kidney stone former status.
- To quantify the contribution of NGIAA to differences between stone formers and non-stone formers.
Main Methods:
- Analysis of data from 6067 participants across three independent cohorts with 24-hour urine collections.
- Exploration of potential determinants of NGIAA, including age, body mass index, and net endogenous acid production.
- Statistical modeling to assess associations between NGIAA, urinary parameters (e.g., supersaturation, pH, citrate, net acid excretion), and stone former status.
Main Results:
- Stone formers consistently showed lower average NGIAA compared to non-stone formers across cohorts.
- NGIAA was inversely associated with calcium oxalate and uric acid supersaturation, and renal net acid excretion.
- Higher NGIAA was directly associated with higher urine pH and citrate levels, and calcium phosphate supersaturation.
Conclusions:
- Kidney stone formers demonstrate significantly lower net gastrointestinal alkali absorption.
- Reduced NGIAA contributes to altered urine composition, including increased supersaturation and reduced citrate.
- Lower NGIAA is linked to a higher likelihood of kidney stone formation, explaining a significant proportion of urine parameter differences.
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