Association of topiramate use with current stone activity: A population-based analysis

It is recognized that topiramate use may affect risk of stone disease, but large population-based and weighted evaluations are absent. Furthermore, the suspected increased odds of stone disease have remained unquantified. We leveraged the nationally representative National Health and Nutrition Examination Survey (NHANES) to perform a population-based assessment of the association of current topiramate use on occurrence of stones presenting within the year immediately preceding survey participation.

We utilized the 2017 - 2020 (Pre-COVID-19) NHANES data to assess association between current topiramate use and incidence of kidney stones. Weights and strata provided by NHANES were employed, and analyses were performed using survey package for STATA v14.

843 participants met analysis criteria, weighted to represent a nationally representative population of 23,064,066 noninstitutionalized U.S. adults. Logistic regression was used to analyze the relationship between the incidence of kidney stone passage in the last 12 months and current topiramate use. It was found that current topiramate use was associated with a statistically significant 810% increase in the odds of stone passage in the last 12 months (OR: 8.1, 95% CI (1.04 - 63.06), p = 0.046). None of the investigated demographic or pharmaceutical covariates (age, diabetes status, body mass index, or concomitant use of diuretics, proton pump inhibitors, or H2-blockers) demonstrated statistically significant association with topiramate use and thus were not included as covariates.

Our results demonstrate that odds of a stone within the last 12 months is increased significantly with topiramate use. Additionally, we provide the initial quantification of the strength of this association, with an estimated 8-fold increase in odds of stone formation. These findings can allow improved risk counseling for patients considering topiramate use for providers.