Association Between Ambient Temperature and Urolithiasis: A Systematic Review and Meta-analysis

The global incidence of urolithiasis has risen in recent decades. Emerging evidence suggests that higher ambient temperatures are linked to an increased risk of kidney-stone-related events, including acute renal colic, likely through physiological mechanisms such as increased urinary calcium excretion and greater supersaturation of calcium oxalate and calcium phosphate. This study aims to systematically review existing evidence on the relationship between ambient temperature and urolithiasis risk.

Of 892 records identified, 46 studies met the inclusion criteria for the systematic review, and 16 were included in the meta-analysis. Most studies reported a positive association between higher ambient temperatures and increased kidney stone-related events, with seasonal peaks occurring during summer months in the Northern Hemisphere and from December to March in Australia. Considerable heterogeneity was observed in exposure definitions, meteorological data sources, outcome ascertainment, and lag structures. Reported effect estimates ranged from RR 1.10 to 2.54. Meta-analysis showed that higher ambient temperature was associated with an increased risk of urolithiasis presentation (pooled RR 1.31, 95% CI 1.21-1.43; I²=86.7%). Subgroup analyses showed pooled RRs of 1.27 (95% CI 1.18-1.37) for stone colic, 1.33 (95% CI 1.06-1.67) for emergency visits, and 1.36 (95% CI 0.98-1.90) for hospitalizations. Associations were stronger at medium and long lag periods than at short lags. Most studies were rated as high risk of bias, primarily because of confounding and outcome measurement concerns. Sensitivity analyses supported the robustness of the findings. This systematic review highlights an association between higher ambient temperatures and increased presentations for kidney stone disease. Addressing environmental factors may be a valuable strategy for reducing nephrolithiasis incidence.