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Original ArticlesNephrolithiasis
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Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers

Linda Shavit, Daniela Girfoglio, Vivek Vijay, David Goldsmith, Pietro Manuel Ferraro, Shabbir H. Moochhala and Robert Unwin
CJASN February 2015, 10 (2) 278-285; DOI: https://doi.org/10.2215/CJN.06030614
Linda Shavit
*Centre for Nephrology, Royal Free Campus and Hospital, University College London Medical School, London, United Kingdom;
†Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel;
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Daniela Girfoglio
*Centre for Nephrology, Royal Free Campus and Hospital, University College London Medical School, London, United Kingdom;
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Vivek Vijay
*Centre for Nephrology, Royal Free Campus and Hospital, University College London Medical School, London, United Kingdom;
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David Goldsmith
‡Nephrology and Transplantation, King's Health Partners Academic Health Sciences Centre, Guy’s Hospital Campus, London, United Kingdom; and
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Pietro Manuel Ferraro
§Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy
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Shabbir H. Moochhala
*Centre for Nephrology, Royal Free Campus and Hospital, University College London Medical School, London, United Kingdom;
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Robert Unwin
*Centre for Nephrology, Royal Free Campus and Hospital, University College London Medical School, London, United Kingdom;
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  • Figure 1.
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    Figure 1.

    Distribution of AAC score in KSFs and healthy controls. The plot shows the distribution of AAC score in participants with and without stones. In the multivariate model adjusted for age, sex, high BP, diabetes, smoking status, and eGFR, the relationship between AAC severity score and kidney stone disease remained significant (P<0.001). The bottom and top of the box represent the first and third quartiles, the line represents the second quartile (median), the whiskers represent 1.5 times the interquartile range of the first and third quartiles, and the circles represent any values lying outside the whiskers. AAC, aortic calcification; KSF, kidney stone former.

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    Figure 2.

    Distribution of CT BMD in KSFs and healthy controls. The plot shows the distribution of CT BMD in participants with and without stones. In the multivariate model adjusted for age, sex, high BP, diabetes, smoking status and eGFR, the relationship between osteoporosis and kidney stone disease remained significant (P<0.001). The bottom and the top of the box represent the first and third quartiles, the line represents the second quartile (median), the whiskers represent 1.5 times the interquartile range of the first and third quartiles, and the circles represent any values lying outside the whiskers. BMD, bone mineral density; CT, computed tomography.

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    Figure 3.

    Distribution of urinary excretion of calcium among KSFs with and without vascular calcification. Urinary excretion of calcium was roughly similar among patients with and without an AAC score >0 (median 280 mg/d [120, 400] versus 288 mg/d [140, 360], P=0.86).The bottom and the top of the box represent the first and third quartiles, the line represents the second quartile (median), and the whiskers represent 1.5 times the interquartile range of the first and third quartiles.

Tables

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    Table 1.

    Baseline clinical characteristics of the patients in the two study groups

    Clinical CharacteristicKSFs (n=57)Non-KSFs (n=54)P Value
    Age, yr47±1447±130.82
    Men32 (56)31 (57)0.89
    Comorbiditiesa
     Systemic hypertension17 (35)5 (9)0.002
     Diabetes mellitus5 (10)1 (2)0.07
     Smokingb4 (12)b16 (30)0.06
    Laboratory results
     Sodium, mEq/L141±2143±20.02
     Potassium, mEq/L4.3±0.34.4±0.30.20
     Calcium, mg/dl9.4±0.49.6±0.40.26
     Phosphorus, mg/dl3.1±0.63.4±0.60.04
     Magnesium, mg/dl0.84±0.12
     Uric acid, mg/dl5.5±1.3
     Urea nitrogen, mg/dl16±5.914.8±2.80.58
     Creatinine, mg/dl1±0.40.9±0.10.45
     eGFR, ml/min–1 per 1.73 m–291±2291±150.31
     Bicarbonate, mEq/L26±225±20.02
     Glucose, mg/dl88±1893±180.08
     Albumin, g/L46±347±30.66
     Parathyroid hormone (range, 1.6–6.9 pmol/L)4.3 (3.1, 6.9)
     25(OH)vitamin D, nmol/L43 (28, 64)
    24-h urine collection (n=36)
     Volume, liters2.0±0.9
     Sodium mEq/d156±46
     Potassium, mEq/d69±20
     Calcium, mg/d280 (124, 400)
     Phosphorus, mg/d806±270
     Oxalate, mg/d30±7.2
     Uric acid, mg/d584±150
     Citrate, mg/d420 (360, 670)
     Creatinine, mg/d1144±352
    • Data are presented as the mean ± SD, n (%), or median (25th percentile, 75th percentile). KSF, kidney stone former.

    • ↵a Comorbidity data were available in 50 KFSs.

    • ↵b Smoking history was available in 24 KFSs.

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    Table 2.

    Incidence of vascular calcification and osteoporosis in KSFs and healthy non-stone formers as detected by the unadjusted analyses

    GroupKSFs (n=57)Non-KSFs (n=54)P Value
    Patients with AAC22/57 (38)19/54 (35)0.69
     Men9/31 (28)9/31(29)
     Women12/23 (52)10/23 (43)
     Median AAC scorea0 (0, 43)0 (0, 10)<0.001
    Patients with osteoporosisb16/51 (31)9/54 (17)0.11
     Men5 (9.8)4 (14)
     Women7 (14)5 (9)
     Average CT BMD, HU159±53194±48<0.001
    • Data are presented as n (%) unless otherwise indicated. AAC, abdominal aortic calcification; CT, computed tomography; BMD, bone mineral density; HU, Hounsfield unit.

    • ↵a AAC score, which was not normally distributed, is shown as the median (25th percentile, 75th percentile).

    • ↵b Osteoporosis is defined as CT attenuation <135 HU at the L1 level. In the KSFs, data were available in 51 patients.

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    Table 3.

    Results of regression models for the estimated difference in AAC or CT BMD between KSFs and non-stone formers

    AnalysisDifference (95% Confidence Interval)Akaike Information CriterionP Value
    AAC
     Univariate3.56 units (3.39 to 3.78)631.030.01
     Multivariate3.78 units (3.53 to 4.06)445.88<0.001
    CT BMD
     Univariate−34.58 HU (−53.85 to −15.32)1110.70<0.001
     Multivariate−35.88 HU (−55.95 to −15.82)870.63<0.001
    • Multivariate models are adjusted for age, sex, high BP, diabetes, smoking status, and eGFR. The r2 statistics are not presented because the model for AAC is a zero-inflated negative binomial and does not allow r2 computation. The Akaike information criterion is presented as a similar measure of fit.

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Clinical Journal of the American Society of Nephrology: 10 (2)
Clinical Journal of the American Society of Nephrology
Vol. 10, Issue 2
February 06, 2015
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Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers
Linda Shavit, Daniela Girfoglio, Vivek Vijay, David Goldsmith, Pietro Manuel Ferraro, Shabbir H. Moochhala, Robert Unwin
CJASN Feb 2015, 10 (2) 278-285; DOI: 10.2215/CJN.06030614

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Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers
Linda Shavit, Daniela Girfoglio, Vivek Vijay, David Goldsmith, Pietro Manuel Ferraro, Shabbir H. Moochhala, Robert Unwin
CJASN Feb 2015, 10 (2) 278-285; DOI: 10.2215/CJN.06030614
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