title: Effect of being overweight on urinary metabolic risk factors for kidney stone formation.
abstract: BACKGROUND
  The prevalence and incidence of kidney stone disease have increased markedly during the past several decades, and studies have demonstrated that inappropriate dietary habits are leading to more obesity and overweight (OW) in children and adults, which may be important in stone formation. Obese and OW patients share most of the same risk factors for cardiovascular morbidity, while the impact of being OW, rather than obese, on urinary metabolic parameters of kidney stone formers (KSF) is less well known. The aims of this study were to investigate urinary metabolic parameters, stone composition and probability of stone formation (Psf) in OW KSF when compared with normal weight (NW) and obese KSF.
  
  
  METHODS
  The kidney stone database for KSF attending a large metabolic stone clinic was investigated. Patients with a recorded BMI, confirmed diagnosis of kidney stone disease and full metabolic evaluation were divided into three categories: BMI ≤25.0 kg/m(2) (NW group), BMI 25-30 kg/m(2) (OW group) and BMI >30.0 kg/m(2) (obese group). Twenty-four hour urinary volume (U.Vol), pH (U.pH), calcium (U.Ca), oxalate (U.Ox), citrate (U.Cit), uric acid (U.UA), magnesium (U.Mg), sodium (U.Na) and potassium (U.K) excretions, along with stone composition and Psf, were then compared among the groups.
  
  
  RESULTS
  A total of 2132 patients were studied, of whom 833 (39%) were NW, 863 (40.5%) were OW and 436 (20.5%) were obese. OW and obese KSF were older (mean age 43 ± 15 in NW, 48 ± 13 in OW and 50 ± 12 years in obese; P for trend <0.001), demonstrated increased female predominance and higher prevalence of diabetes, hypertension and gout. There were no statistically significant differences in U.Vol and U.Mg among the groups. However, significantly higher levels of U.Ca, U.Ox, U.Cit, by crude analysis, and U.UA (3.3 ± 1.1 versus 3.8 ± 1.2 versus 4.0 ± 1.2 mmol/L; P < 0.001 for trend), U.Na (151 ± 57 versus 165 ± 60 versus 184 ± 63 mmol/L; P < 0.001 for trend), and lower U.pH (6.3 ± 0.5 versus 6.1 ± 0.5 versus 6.0 ± 0.6; P < 0.001 for trend) by both crude and multivariate adjusted analysis models were demonstrated in OW and obese KSF. Stone composition data (N = 640) showed a significantly higher incidence of uric acid stones in OW and obese groups (P for trend < 0.001). In addition, higher Psf for CaOx, UA and CaOx/UA stone types were detected in OW and obese compared with NW KSF.
  
  
  CONCLUSIONS
  Similar to obese KSF, OW KSF show clear alterations in metabolic urinary profiles that are associated with increased overall risk of stone formation. This greater risk is primarily due to raised U.UA and U.Na, lower U.pH and higher prevalence of hypercalciuria, along with unchanged levels of the commonly measured urinary lithogenesis inhibitors. Moreover, our study established a higher incidence of uric acid, but not calcium, stones in OW KSF. Thus, appropriate evaluation and follow-up may be warranted even in OW patients who are at risk of increased stone formation. Whether modest weight loss in OW KSF will have a favourable impact on their metabolic urinary profiles and thereby diminish the risk of further stone formation needs exploring.
authors.affiliation: UCL Centre for Nephrology, University College London Medical School, Royal Free Campus and Hospital, London, UK Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Linda
authors.initials: L
authors.lastname: Shavit
authors.affiliation: Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Pietro Manuel
authors.initials: PM
authors.lastname: Ferraro
authors.affiliation: UCL Centre for Nephrology, University College London Medical School, Royal Free Campus and Hospital, London, UK.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Johri
authors.affiliation: UCL Centre for Nephrology, University College London Medical School, Royal Free Campus and Hospital, London, UK Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: William
authors.initials: W
authors.lastname: Robertson
authors.affiliation: UCL Centre for Nephrology, University College London Medical School, Royal Free Campus and Hospital, London, UK.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Walsh
authors.affiliation: UCL Centre for Nephrology, University College London Medical School, Royal Free Campus and Hospital, London, UK.
authors.forename: Shabbir
authors.initials: S
authors.lastname: Moochhala
authors.affiliation: UCL Centre for Nephrology, University College London Medical School, Royal Free Campus and Hospital, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Unwin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000209:etiology* / Q000378:metabolism; D008297:Male; D055442:Metabolome; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000378:metabolism*; D050177:Overweight / Q000150:complications* / Q000378:metabolism; D012307:Risk Factors; D016482:Urinalysis
keywords: BMI; diet; nephrolithiasis; oxalate; uric acid