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Stone composition, insulin therapy predict stone recurrence in T2DM patients

10 Apr 2020
Raising fluid intake and drug therapy if increased fluid intake is inadequate are among the new recommendations.

Insulin therapy and stone composition are significantly associated with kidney stone recurrence in patients with type 2 diabetes mellitus (T2DM), while HbA1c and urine pH are modifiable factors, suggests a recent study.

The researchers performed a cross-sectional analysis of stone recurrence from January 2013 to August 2019 using their database of T2DM patients diagnosed with stone disease between 2002 and 2012. Patients were grouped according to their stone disease status: recurrent stone and nonrecurrent stone. Their baseline characteristics were also compared. Logistic regression was done to determine which variables could predict a stone recurrence.

A total of 1,617 T2DM patients with stone disease were included in the analysis, of whom 1,244 (77 percent) did not have a stone recurrence and 373 (23 percent) had a stone recurrence. Among those with recurrent stone, 40 percent had asymptomatic stones, 43 percent required emergency department visits, and 45 percent required a surgical intervention. Median time to recurrence was 64 months.

In multivariable analysis, stone recurrence was significantly predicted by the following factors: age (odds ratio [OR], 0.973, 95 percent confidence interval [CI], 0.961–0.985), insulin therapy (OR, 0.564, 95 percent CI, 0.399–0.798), HbA1c (OR, 1.093, 05 percent CI, 1.007–1.186), urine pH (OR, 0.799, 95 percent CI, 0.674–0.947), and stone with calcium oxalate (OR, 1.771, 95 percent CI, 1.303–2.418) and uric acid composition (OR, 2.312, 95 percent CI, 1.316–4.063).

“The presence and severity of T2DM are associated with kidney stone disease,” the researchers said.

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