Link between nephrolitiasis and the metabolic syndrome?

1. Link between nephrolitiasis and the metabolic syndrome?  C. Dzien 1) , C. Dzien-Bischinger 1)A. Dzien1) Medical Center Hentschelhof1) A-6020Innsbruck, Austria

2. Objectives The incidence of nephrolithiasis is given in means at 5%. The aim of our study was to investigate this incidence in a population of western Austria and to find possible correlations with routine parameters daily used and comorbidities. A further aim was to study a possible relationship with symptoms of the metabolic syndrome.

3. Methods In order to answer this question, a database collected by our medical outdoor center was evaluated. During a period of 22 years (1992-2014) 14.640 patients attended our medical practice, women N=8.697, men N=6.043. All of  them were consecutively admitted to our medical center for diagnostic and therapeutics procedures

4. Methods Data collected for all patients included: gender, age, body mass index (BMI), body composition monitor (BCM), RR-sys, RR-dias, creatine, GFR, Na+, K+, Ca2+, Mg 2+, f-glucose, cholesterol, HDL-chol, LDL-chol, triglyceride, TSH During the evaluation period we have collected 140.582 ICD-10 diagnoses.

5. Methods We are working with SQL data bank between 1992 to 2014 • PATIENT: sex, title, name, date of birth, body size, profession, insurance, primary care physician, sports, nicotine consumption, food frequency questionare • TREATMENT: date, treatment, weight, blood pressure (RR), BMI, HWR, body fat% ECG: SR PQ time • LABORATORY: Laboratory species type all laboratoryparametersarerecorded in ourdatabase. In addition, the metric parameters of diagostic tests are recorded: (ergometry, etc.) • THERAPY: drug, initiationand end oftherapy , daily dose • DRUGS: drug, ingredient, genericon, dosage, unit • DIAGNOSIS: date, VESCA-ICD 10 diagnostic codesadress

6. Methods Nephrolithiasis was diagnosed in 261 patients (group 1) Characteristics of group 1: N = 261, fasting-glucose 95,1(±11,2)mg/dl, age 54.89 (±5.34) years, women N = 114, men N = 147 A matched control group was characterized (group 2) by: N = 890, fasting-glucose 96,8(±12)mg/dl, age 54,02(±6,06) years, women N = 443, men N = 447.  Fasting-glucose and age were in both groups not significantly different

8. Results The diagnosis of nephrolithiasis was made at an age of 49.3 (±19.25) years, median 48.3 years. The incidence of nephrolithiasis in our population was 1,72%. The incidence of nephrolithiasis in summary of data was 0,2%.

9. Differences in laboratory values group 1 group 2(nephrolithiasis) (without nephrolithiasis) • bodysize(cm): 172 (8,91) 176 (9,14) P <0,05 • BCM(body fat %):28,5 (7,57) 26,9 (7,2 1) p <0,05 • RR sys.(mmHg): 140 (21,66) 134 (18,1) p <0,03 • RR dia.(mmHg): 86 (10,47) 84 (10,45) p <0,01 • uric acids(µg/ml): 5,31 (1,78) 4,93 (1,59) p <0,04 • creatine(µg/ml) 1,05 (0,27) 0,97 (0,27) p <0,01 • HDL-chol.(µg/ml): 54,3 (16,5) 59,3 (16,5) p <0,01 • Prevalenceof DM2: 29% 15%

10. Results • At the end of our observation the prevalence of type 2 diabetes was higher in the group of patients with nephrolithiasis compared to the control group. • Patients with nephrolithiasis revealed lower HDL-chol. levels and higher blood pressures then the control group. (Indicating a higher prevalence of a metabolic syndrome) • The comorbidity of group 1 with 17.9 diagnoses per patient was significantly higher compared with group 2 with 12.2 diagnoses per patient.

11. Conclusion • In a medical outdoor center in Innsbruck nephrolithiasis shows with 1,72% a lower incidence than reported in the literature. • The nephrolithiasis patients are more labor intensive because of the significantly higher comorbidity in particular a high proportion of diabetes mellitus 2b compared to the control group. •  Our data shows possible connections between nephrolithiasis and the metabolic syndrome. The early manifestation of nephrolithiasis may be the reason for the missing difference in f-glucose and triglyceride values.