Cumulative antibiotic use tied to later risk for kidney stones

  • Ferraro PM & al.
  • Am J Kidney Dis
  • 17 Sep 2019

  • International Clinical Digest
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Takeaway

  • Cumulative use of antibiotics for ≥2 months in early adulthood and middle age is tied to an increased risk for kidney stones in later life.

Why this matters

  • Antibiotics alter the intestinal microbiome, potentially affecting kidney stone development by modulating oxalate absorption and excretion.

Study design

  • Data for 5010 women in the prospective Nurses’ Health Studies (NHS) I and II with available 24-hour urine samples.
  • Analysis adjusted for age, BMI, comorbidities, thiazide use, and dietary factors.
  • Funding: NIH.

Key results

  • Indications most commonly included respiratory infection (52%-53%), UTIs (11%-15%), and dental infections (7%-10%).
  • Aged 40-49/59 years: 1059 subsequent kidney stone incidents over 694,194 person-years.
    • Risk was 48% higher with cumulative antibiotic use ≥2 months vs no use (pooled HR, 1.48; 95% CI: 1.12-1.96).
  • Aged 20-39 years: 1059 subsequent kidney stone incidents over 694,193 person-years.
    • Risk was 36% higher with cumulative antibiotic use ≥2 months vs no use (pooled HR, 1.36; 95% CI: 1.00-1.84).
  • Findings were consistent after excluding patients reporting UTIs as the most common indication, or UTIs with kidney stones.
  • Urine pH and citrate levels were marginally lower with ≥2 months of antibiotic use.

Limitations

  • Observational design.
  • May not extrapolate to men.
  • Antibiotic type was not captured.
  • Interval between antibiotic use, urine collection.

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