Risk of Hypertension among First-Time Symptomatic Kidney Stone Formers
Risk of Hypertension among First-Time Symptomatic Kidney Stone Formers
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DOI：
10.2215/cjn.06600616
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发表时间：
2017-03-01
影响因子：
9.8
通讯作者：
Rule, Andrew D.
中科院分区：
文献类型：
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作者：
Kittanamongkolchai, Wonngarm;Mara, Kristin C.;Rule, Andrew D.
背景和目的先前的研究表明，肾结石患者患高血压的风险更高，但缺乏对潜在混杂因素的疾病验证和调整。某些类型的结石形成者也可能有更高的高血压风险。在我们的研究中，2000年至2011年在奥姆斯特县发生的有症状的结石形成者的设计、设置、参与者和测量通过图表回顾和与奥姆斯特县对照的年龄和性别匹配来手动验证。我们在2015年11月20日对患者进行了跟踪调查。高血压也通过手动图检查得到验证，与对照组相比，结石患者的高血压风险被单变量评估，并在调整了合并症后进行评估。结果在2000年至2011年的3023例编码结石患者中，共有1515例获得验证并与1515例对照(平均年龄45岁，其中56%为男性)相匹配。排除基础高血压(20%的结石患者和18%的对照组)后，154名结石患者和110名对照组发展为高血压。结石形成组的中位随访期为7.8年，对照组为9.6年。研究发现，即使在调整了年龄、性别、体重指数、血肌酐、慢性肾脏病、糖尿病、痛风、冠心病、血脂异常、吸烟和酗酒等因素后，结石患者仍比对照组有更高的高血压风险(危险比1.50；95%可信区间1.18至1.92)。排除曾服用噻嗪类利尿剂的患者后，结果相似(危险比为1.65；95%可信区间为1.16至2.38)。结石成分、放射学结石负荷、后续结石事件次数和结石取出手术与高血压无关(均为P&gT；0.05)。结论首次出现症状性肾结石事件后发生高血压的风险较高。然而，肾结石的严重程度、类型和治疗与高血压无关。
Background and objectives Prior work has suggested a higher risk of hypertension in kidney stone formers but lacked disease validation and adjustment for potential confounders. Certain types of stone formers may also be at higher risk of hypertension.Design, setting, participants, & measurements In our study, incident symptomatic stone formers in Olmsted County from2000 to 2011 were manually validated by chart review and age and sex matched to Olmsted County controls. We followed up patients throughNovember 20, 2015. Hypertension was also validated bymanual chart review, and the risk of hypertension in stone formers comparedwith controlswas assessed both univariately and after adjusting for comorbidities. The risk of hypertension among different subtypes of stone formers was also evaluated.Results Among 3023 coded stone formers from 2000 to 2011, a total of 1515 were validated and matched to 1515 controls(mean agewas 45 years old, and56% weremen). After excludingthosewithbaselinehypertension(20% of stone formers and18% of controls), 154 stone formers and110 controlsdevelopedhypertension. Median follow-up time was 7.8 years in stone formers and 9.6 years in controls. Stone formers were found to have a higher risk of hypertension compared with controls (hazard ratio, 1.50; 95% confidence interval, 1.18 to 1.92), even after adjusting for age, sex, body mass index, serum creatinine, CKD, diabetes, gout, coronary artery disease, dyslipidemia, tobacco use, and alcohol abuse (hazard ratio, 1.58; 95% confidence interval, 1.12 to 2.21). Results were similar after excluding patients who were ever on a thiazide diuretic (hazard ratio, 1.65; 95% confidence interval, 1.16 to 2.38). Stone composition, radiographic stone burden, number of subsequent stone events, and stone removal surgeries were not associated with hypertension (P>0.05 for all).Conclusions The risk of hypertensionwas higher after the first symptomatic kidney stone event. However, kidney stone severity, type, and treatment did not associate with hypertension.