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MP01-17 AGE, SEX, AND CLIMATE DIFFERENCES IN THE TEMPERATURE- DEPENDENCE OF KIDNEY STONE PRESENTATION

Article in The Journal of Urology · April 2017

DOI: 10.1016/j.juro.2017.02.092

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9 authors, including: Some of the authors of this publication are also working on these related projects: NiCK Study View project Organize cyber crime View project Gregory Edward Tasian The Children's Hospital of Philadelphia

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comprehensive teaching strategies for patients regarding the modifiable risk factors for nephrolithiasis. Source of Funding: none

MP01-16

METABOLIC SYNDROME INCREASES THE RISK FOR CALCIUM OXALATE STONE FORMATION: RESULTS FROM A NATIONWIDE SURVEY ON UROLITHIASIS IN JAPAN Akinori Iba*, Yasuo Kohjimoto, Takashi Iguchi, Shimpei Yamashita, Satoshi Nishizawa, Kazuro Kikkawa, Isao Hara, Wakayama, Japan INTRODUCTION AND OBJECTIVES: Recent epidemiologic studies have shown an increased prevalence of kidney stones in pa- tients with metabolic syndrome (MetS). We have reported that the clustering of MetS traits is associated with greater severity of kidney stone disease (Am J Kidney Dis 61: 923-929, 2013). The aim of the present study is to clarify which stone composition is associated with MetS. METHODS: We retrospectively analyzed detailed clinical data from 30,448 patients with urolithiasis enrolled in the 6th Nationwide Survey on Urolithiasis in Japan conducted in 2005. Patients with lower urinary tract stones, struvite stones, cystine stones, other types of rare stone composition, unknown stone composition, or hyperparathyroidism and those younger than 15 years were excluded. According to the types

• f stone composition, the severity of kidney stone disease, assessed by

the number of existing stones (single/multiple) and number of stone episodes (first time/recurrent), and abnormalities in urine constituents were examined by the number of MetS traits (obesity, hypertension, dyslipidemia, and diabetes). RESULTS: A total of 4,440 patients included in the final ana- lyses were classified into four groups: calcium oxalate (CaOx) (n¼3213), CaOx + calcium phosphate (CaP) (n¼881), CaP (n¼115), uric acid (UA) (n¼191). The proportions of patients with recurrent and/or multiple stones significantly increased with the number of MetS traits

• nly in patients with CaOx stone (P < 0.01, table 1). However, similar

associations were not observed in patients with other stone composi-

• tions. In patients with CaOx stone, there was a significant and stepwise

increase in the odds of recurrent and/or multiple stones after adjustment for age and sex. In patients with 3 or 4 MetS traits, the odds was 1.8-fold greater compared with patients with 0 traits (OR, 1.78; 95% CI, 1.29- 2.42). In addition, the presence of MetS traits was associated with significantly increased odds of having hypercalciuria in patients with CaOx stone after adjustment for age and sex. CONCLUSIONS: In patients with CaOx stone, MetS trait clus- tering is associated with greater severity of the disease and increased urinary calcium excretion. These results suggest that CaOx stone dis- ease should be regarded as a systemic disorder linked to MetS. Source of Funding: none

MP01-17

AGE, SEX, AND CLIMATE DIFFERENCES IN THE TEMPERATURE-DEPENDENCE OF KIDNEY STONE PRESENTATION Gregory Tasian*, Philadelphia, PA; Ana Vicedo-Cabrera, Basel, Switzerland; Robert Kopp, New Brunswick, NJ; Lihai Song, Michelle Ross, Jose Pulido, Steven Warner, Philadelphia, PA; David Goldfarb, New York, NY; Susan Furth, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Prior studies have demonstrated that high daily temperatures increase the risk of kidney stone presentation, men produce more sweat than women, and people with public insurance have greater exposure to ambient temperatures than those with private insurance. The objective of this study was to determine differences in the temperature dependence of kidney stone presentation by sex, age, race, climate, and insurance type. METHODS: We performed a time series study of 132,597 pa- tients who presented with kidney stones to Emergency Departments in South Carolina from 1996-2015. Conditional Poisson regression and distributed lag non-linear models were used to assess the association and lagged response between daily temperature and kidney stone presentation stratified by sex, age, insurance type, race, and climate zone. RESULTS: The relative risk for a daily temperature at the 99th percentile versus 10C was 1.72 (95% CI 1.55, 1.91) for men and 1.15 (95% CI 1.01, 1.31) for women. This difference was greatest among patients 20-65 years old. The risk of kidney stone presentation following moderately high daily temperatures was less among patients living in warmer climates. The temperature-dependence of stone presentation did not differ by race or insurance type. CONCLUSIONS: The risk

• f

kidney stone presentation following high daily temperatures was substantially greater among men than women and similar between patients with public and private in- surance, which suggests that the higher risk among men is due to the sexually dimorphic effect of heat on evaporative water loss rather than greater exposure to ambient temperature. The lower risk among pa- tients living in warmer climates suggests that prolonged heat exposure

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THE JOURNAL OF UROLOGY e7

may lead to adaptive responses that mitigate the effect of high tem- peratures on kidney stone presentation. These differences should be considered in secondary prevention strategies to increase fluid intake and projections of the effect of climate change on nephrolithiasis prevalence. Source of Funding: NIH K23DK106428

MP01-18

PRECIPITATION (AND NOT TEMPERATURE) IS ASSOCIATED WITH URINARY STONE DISEASE IN CALIFORNIA Kai Dallas*, Stanford, CA; Simon Conti, John Leppert, Palo Alto, CA; Christopher Elliott, Santa Clara, CA; Mario Sofer, Tel Aviv, Israel; Alan Thong, Palo Alto, CA INTRODUCTION AND OBJECTIVES: It is commonly accepted that increased temperatures are associated with increased prevalence

• f kidney stone disease. When examining stone mapping studies of the

United States, while some regions with high annual temperatures (the southeast) have higher kidney stone prevalence, other warm regions such as the southwest do not. One major climate difference between these two regions is annual precipitation and humidity. We sought to explore the associations among, temperature, precipitation and urinary stone disease. METHODS: We identified all patients who underwent uretero- scopy, percutaneous nephrolithotomy, or shock wave lithotripsy using data from the Office of Statewide Health Planning and Development (OSHPD) for the state of California (2010-2012). We calculated the rate

• f operative stone disease for each county based on the patient’s home
• zipcode. We obtained climate data for each county in California from the

National Oceanic and Atmospheric Administration. We compared the rate of urinary stone surgeries, adjusted for county population, mean annual temperature, total number of days over 90 degrees, and the total annual precipitation. RESULTS: A total of 63,994 unique patients underwent stone procedures in California between 2010-2012. The mean county stone surgery rate was 1.77 cases per 1000 persons (range 0.05-3.16). In the lowest quartile of rainfall (less than 21 inches per year), the average stone surgery rate was 1.5 per 1000 persons. This was significantly less than 2.2 per 1000 persons in the regions with the highest quartile of rainfall (44 inches per year) (p<0.01). In fully-adjusted models, precip- itation (0.019 increase in surgeries per 1000 persons per inch, p<0.01) and higher mean temperature (0.029 increase in surgeries per 1000 persons per degree, p<0.01) were associated with an increased rate of stone surgery (Figure 1). The effect of temperature was not significant unless precipitation was controlled for. CONCLUSIONS: In the state of California, temperature alone is not associated with the county-level rate of stone surgery until precipitation is included in models. Our results appear to agree with the larger trends seen through the United States where the areas of highest stone prevalence have warm humid climates, and not warm arid, climates. Source of Funding: none

MP01-19

RECENT EPIDEMIOLOGICAL AND METABOLIC TRENDS IN STONE DISEASE: RISING HYPOCITRATURIA AND HYPEROXALURIA Ramy F. Youssef, Jeremy W. Martin*, Orange, CA; Khashayar Sakhaee, John Poindexter, Dallas, TX; Simone L. Vernez, Rahul Dutta, Orange, CA; Charles D. Scales, Glenn M. Preminger, Michael E. Lipkin, Durham, NC INTRODUCTION AND OBJECTIVES: Metabolic factors un- derlying the recent increase in stone prevalence are unknown. Herein, we evaluate metabolic risk factors in stone patients from two different decades, comparing changes in metabolic profiles of stone formers

• ver time.

METHODS: A retrospective review was performed of patients who underwent metabolic evaluation of urolithiasis with 24-hour urine collections at a single institution. There were 309 stone patients eval- uated from 1988-1994 (group 1), and 229 patients from 2007-2010 (group 2). A comparison between both groups was performed to assess changes in demographics and metabolic profiles. RESULTS: Comparing group 1 to group 2, the male: female ratio decreased from 1.3:1 to 0.8:1, obese patients (BMI 30) increased from 22% to 35%, and patients 50 y increased from 29% to 47% (all p < .005). A greater percentage of patients had hypocitraturia in the recent cohort (46% to 60%, p ¼ .001), with hypocitraturia significantly more frequent in obese patients (p ¼ .005). Hyperoxaluria was also increased in group 2 compared to group 1 (23% to 30% p ¼ .07), a finding that was significant in males (32% to 53%, p ¼ .001). CONCLUSIONS: Urolithiasis has increased in females, obese, and older patients, consistent with population based studies. We report a rising incidence of hypocitraturia and hyperoxaluria in the contem- porary cohort, particularly in obese patients and in males, respectively. Further studies are needed to better characterize the metabolic changes corresponding to the increase in stone disease. Source of Funding: None e8 THE JOURNAL OF UROLOGY

• Vol. 197, No. 4S, Supplement, Friday, May 12, 2017

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