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PD51-08 VITAMIN D DEFICIENCY TREATED WITH WEEKLY 50,000 IU VITAMIN D SUPPLEMENTATION INCREASES RENAL STONE RISK
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
Statistical analysis was used to compare results of the physicians’ responses to the survey regarding their patient’s hydration and nutrition status. RESULTS: Hydration score and diet score did not differ significantly across physician. The odds of a diet score change was significantly higher for patients who consumed more sodium (p ¼ 0.012) or more fluids (p ¼ 0.04). There is no difference in the odds of a change in hydration score for patients who consumed oxalate, calcium, sodium, purine or water. Oxalate consumption was positively correlated with the decision for additional intervention. The following foods have significant relationships with change in score or intervention: raspberries (p ¼ 0.0067), cashews (p ¼ 0.04), table salt (p¼0.04), smoothies (p¼0.02), kale (p¼0.0032), other caffeinated drinks (p¼0.02), pork (p¼0.02), restaurant meals (p¼0.02), and vegetables (p¼0.0443). CONCLUSIONS: Information derived from the food frequency questionnaire can yield a significant impact on a physician’s decision for treatment and management of stone disease. Source of Funding: Diversity and Inclusion Grant, Office of the ProvostMidwest Stone Institute Research Directors’ Fund
e1111
Baseline Characteristics of Vitamin D deficient patients prescribed Vitamin D supplementation Total N (%)
50,000 I.U. Vit D N (%)
Usual Treatment N (%)
p value
Total Number Patients
25805
9273 (35.9)
16532 (64.1)
Male Gender
8648 (33.5)
2752 (29.7)
5896 (35.7)
< 0.001
Caucasian
15905 (61.7)
5229 (56.4)
10676 (64.7)
< 0.001
African American
1636 (6.3)
930 (10)
706 (4.3)
< 0.001
Asian
1458 (5.7)
605 (6.5)
853 (5.2)
< 0.001
Other
6765 (26.3)
2509 (27.1)
4256 (25.8)
< 0.001
Age (Years) Mean SD
51.1 15.3
50 14.9
51.7 15.5
< 0.001
Lowest Vitamin D level SD
22.4 6.7
19.6 6.9
24.0 6.2
< 0.001
BMI Mean SD
29.1 7.1
30.6 8.1
28.2 6.2
< 0.001
610 (2.4)
255 (2.8)
355 (2.2)
0.002
New Kidney Stone formation
Source of Funding: None
PD51-08 VITAMIN D DEFICIENCY TREATED WITH WEEKLY 50,000 IU VITAMIN D SUPPLEMENTATION INCREASES RENAL STONE RISK Sangtae Park*, Natalie Fahey, Brittany Lapin, Jaclyn Pruitt, Chi Wang, Evanston, IL INTRODUCTION AND OBJECTIVES: The Endocrine Society published Clinical Practice Guidelines in 2011 recommending weekly 50,000 IU Vitamin D3 (50K D3) supplementation for 8 weeks in 25hydroxy Vitamin D (25(OH)D) deficient patients. While 25(OH)D deficiency is highly prevalent in the general population and in stone formers, there is no consensus on whether Vitamin D supplementation impacts nephrolithiasis risk. We aimed to determine whether 50K D3 increases new stone formation in previously stone-free, Vitamin D deficient patients. METHODS: We queried the NorthShore University HealthSystem Electronic Data Warehouse (EPIC EMR integrated since 2001) for all patients with no history of nephrolithiasis, diagnosed with new 25(OH)D deficiency (<32ng/mL) in 2011. These patients’ demographics, stone risk factors, and Vitamin D prescription data were collected. After 3 years’ follow up (2011-2014), the incidence of new nephrolithiasis was compared between patients receiving and not receiving 50K D3 prescriptions using multivariate logistic regression in SAS 9.4 (Cary, NC). RESULTS: At our institution in 2011, 48,697 patients without prior stones were tested for 25(OH)D and 25,805 (53%) were diagnosed with Vitamin D deficiency. 33.5% were men, 61.7% Caucasian, and the mean 25(OH)D level was 22.4 ng/mL (Table 1). Upon diagnosis, 9,273 patients (35.9%) were prescribed 50K D3, whereas the remainder were not. Women, non-Caucasians, higher BMI, younger age and lower 25(OH)D level (19.6 vs. 24.0) patients were more likely to be prescribed 50K D3 (all p values < 0.001) After 3 years’ follow-up, 610 patients overall had developed their first renal stone, with a significantly higher incidence in those prescribed 50K D3 (2.8% versus 2.2%) compared to those receiving lower supplementation (Univariate odds ratio ¼1.29, 95% CI 1.10-1.52, p¼0.002) Multivariate analysis adjusting for gender, race, age, BMI, 25(OH)D level confirmed an odds ratio of 1.25 (95% CI 1.05-1.50, p ¼0.012) for high dose Vitamin D supplementation on new kidney stone formation. CONCLUSIONS: In this heretofore uninvestigated question, weekly 50,000 IU Vitamin D supplementation is associated with a 25% increased stone risk in previously stone-free, Vitamin D deficient patients.
PD51-09 HIGH PREVALENCE OF KIDNEY STONES IN PEDIATRIC PATIENTS WITH ASTHMA Ganesh Kartha*, Suzy Comhair, Manoj Monga, Serpil C. Erzurum, Cleveland, OH INTRODUCTION AND OBJECTIVES: Cystic Fibrosis patients have an increased incidence of stone formation, but associations between other obstructive lung diseases and stone formation are unknown. We hypothesized that pediatric patients with a diagnosis of asthma would have an increased prevalence of nephrolithiasis. Furthermore, we sought to determine if asthma patients with stones have clinical or demographic characteristics and 24 hour urine profiles that may point to mechanisms of stone formation. METHODS: Using our IRB-approved kidney stone database, we evaluated data from 865 patients who had a diagnosis of nephrolithiasis prior to the age of 18. Clinical and demographic data and 24 hour urine samples were compared between asthma þ stone (AS) and stone only (S) patients. Data from asthmatics without stones were also available for evaluation of differences among AS and asthma only (A) patients. RESULTS: The prevalence of nephrolithiasis in the pediatric population at our institution was 0.09%, however it was 0.28% in our pediatric asthmatic population. The prevalence of asthma in our pediatric population was 5.96%, however it was 19.49% in our pediatric stone patients and 30.47% in pediatric stone patients younger than 12 years of age. As compared to S patients, AS patients were more likely to be male (51.06 vs 41.99%, p¼0.047) and have a stone diagnosis at an earlier age (12.33 vs. 13.51 years, p¼0.038). AS patients were more likely to be on a combination inhaled corticosteroid þ long acting beta agonist inhaler as compared to age/gender/BMI matched asthma patients without stone (26.9 vs. 12.1%, p¼0.012). There was no difference in other asthma medications between the groups (inhaled beta agonists, inhaled corticosteroid, or any anti-asthmatic medication). 259 stone patients had available 24 hour urine samples for comparison (Table 1). There was no difference in 24 hour urine profiles between AS and S patients. CONCLUSIONS: Children with asthma have 3-fold greater likelihood of having kidney stones than the general pediatric population. Similarly, children with stones have a 5-fold greater likelihood of having asthma, such that 1/3 children with stones under the age of 12 have asthma. The data suggests a mechanistic link between asthma and nephrolithiasis. Further investigation is needed to elucidate the pathophysiologic origin of this relationship.
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
Statistical analysis was used to compare results of the physicians’ responses to the survey regarding their patient’s hydration and nutrition status. RESULTS: Hydration score and diet score did not differ significantly across physician. The odds of a diet score change was significantly higher for patients who consumed more sodium (p ¼ 0.012) or more fluids (p ¼ 0.04). There is no difference in the odds of a change in hydration score for patients who consumed oxalate, calcium, sodium, purine or water. Oxalate consumption was positively correlated with the decision for additional intervention. The following foods have significant relationships with change in score or intervention: raspberries (p ¼ 0.0067), cashews (p ¼ 0.04), table salt (p¼0.04), smoothies (p¼0.02), kale (p¼0.0032), other caffeinated drinks (p¼0.02), pork (p¼0.02), restaurant meals (p¼0.02), and vegetables (p¼0.0443). CONCLUSIONS: Information derived from the food frequency questionnaire can yield a significant impact on a physician’s decision for treatment and management of stone disease. Source of Funding: Diversity and Inclusion Grant, Office of the ProvostMidwest Stone Institute Research Directors’ Fund
e1111
Baseline Characteristics of Vitamin D deficient patients prescribed Vitamin D supplementation Total N (%)
50,000 I.U. Vit D N (%)
Usual Treatment N (%)
p value
Total Number Patients
25805
9273 (35.9)
16532 (64.1)
Male Gender
8648 (33.5)
2752 (29.7)
5896 (35.7)
< 0.001
Caucasian
15905 (61.7)
5229 (56.4)
10676 (64.7)
< 0.001
African American
1636 (6.3)
930 (10)
706 (4.3)
< 0.001
Asian
1458 (5.7)
605 (6.5)
853 (5.2)
< 0.001
Other
6765 (26.3)
2509 (27.1)
4256 (25.8)
< 0.001
Age (Years) Mean SD
51.1 15.3
50 14.9
51.7 15.5
< 0.001
Lowest Vitamin D level SD
22.4 6.7
19.6 6.9
24.0 6.2
< 0.001
BMI Mean SD
29.1 7.1
30.6 8.1
28.2 6.2
< 0.001
610 (2.4)
255 (2.8)
355 (2.2)
0.002
New Kidney Stone formation
Source of Funding: None
PD51-08 VITAMIN D DEFICIENCY TREATED WITH WEEKLY 50,000 IU VITAMIN D SUPPLEMENTATION INCREASES RENAL STONE RISK Sangtae Park*, Natalie Fahey, Brittany Lapin, Jaclyn Pruitt, Chi Wang, Evanston, IL INTRODUCTION AND OBJECTIVES: The Endocrine Society published Clinical Practice Guidelines in 2011 recommending weekly 50,000 IU Vitamin D3 (50K D3) supplementation for 8 weeks in 25hydroxy Vitamin D (25(OH)D) deficient patients. While 25(OH)D deficiency is highly prevalent in the general population and in stone formers, there is no consensus on whether Vitamin D supplementation impacts nephrolithiasis risk. We aimed to determine whether 50K D3 increases new stone formation in previously stone-free, Vitamin D deficient patients. METHODS: We queried the NorthShore University HealthSystem Electronic Data Warehouse (EPIC EMR integrated since 2001) for all patients with no history of nephrolithiasis, diagnosed with new 25(OH)D deficiency (<32ng/mL) in 2011. These patients’ demographics, stone risk factors, and Vitamin D prescription data were collected. After 3 years’ follow up (2011-2014), the incidence of new nephrolithiasis was compared between patients receiving and not receiving 50K D3 prescriptions using multivariate logistic regression in SAS 9.4 (Cary, NC). RESULTS: At our institution in 2011, 48,697 patients without prior stones were tested for 25(OH)D and 25,805 (53%) were diagnosed with Vitamin D deficiency. 33.5% were men, 61.7% Caucasian, and the mean 25(OH)D level was 22.4 ng/mL (Table 1). Upon diagnosis, 9,273 patients (35.9%) were prescribed 50K D3, whereas the remainder were not. Women, non-Caucasians, higher BMI, younger age and lower 25(OH)D level (19.6 vs. 24.0) patients were more likely to be prescribed 50K D3 (all p values < 0.001) After 3 years’ follow-up, 610 patients overall had developed their first renal stone, with a significantly higher incidence in those prescribed 50K D3 (2.8% versus 2.2%) compared to those receiving lower supplementation (Univariate odds ratio ¼1.29, 95% CI 1.10-1.52, p¼0.002) Multivariate analysis adjusting for gender, race, age, BMI, 25(OH)D level confirmed an odds ratio of 1.25 (95% CI 1.05-1.50, p ¼0.012) for high dose Vitamin D supplementation on new kidney stone formation. CONCLUSIONS: In this heretofore uninvestigated question, weekly 50,000 IU Vitamin D supplementation is associated with a 25% increased stone risk in previously stone-free, Vitamin D deficient patients.
PD51-09 HIGH PREVALENCE OF KIDNEY STONES IN PEDIATRIC PATIENTS WITH ASTHMA Ganesh Kartha*, Suzy Comhair, Manoj Monga, Serpil C. Erzurum, Cleveland, OH INTRODUCTION AND OBJECTIVES: Cystic Fibrosis patients have an increased incidence of stone formation, but associations between other obstructive lung diseases and stone formation are unknown. We hypothesized that pediatric patients with a diagnosis of asthma would have an increased prevalence of nephrolithiasis. Furthermore, we sought to determine if asthma patients with stones have clinical or demographic characteristics and 24 hour urine profiles that may point to mechanisms of stone formation. METHODS: Using our IRB-approved kidney stone database, we evaluated data from 865 patients who had a diagnosis of nephrolithiasis prior to the age of 18. Clinical and demographic data and 24 hour urine samples were compared between asthma þ stone (AS) and stone only (S) patients. Data from asthmatics without stones were also available for evaluation of differences among AS and asthma only (A) patients. RESULTS: The prevalence of nephrolithiasis in the pediatric population at our institution was 0.09%, however it was 0.28% in our pediatric asthmatic population. The prevalence of asthma in our pediatric population was 5.96%, however it was 19.49% in our pediatric stone patients and 30.47% in pediatric stone patients younger than 12 years of age. As compared to S patients, AS patients were more likely to be male (51.06 vs 41.99%, p¼0.047) and have a stone diagnosis at an earlier age (12.33 vs. 13.51 years, p¼0.038). AS patients were more likely to be on a combination inhaled corticosteroid þ long acting beta agonist inhaler as compared to age/gender/BMI matched asthma patients without stone (26.9 vs. 12.1%, p¼0.012). There was no difference in other asthma medications between the groups (inhaled beta agonists, inhaled corticosteroid, or any anti-asthmatic medication). 259 stone patients had available 24 hour urine samples for comparison (Table 1). There was no difference in 24 hour urine profiles between AS and S patients. CONCLUSIONS: Children with asthma have 3-fold greater likelihood of having kidney stones than the general pediatric population. Similarly, children with stones have a 5-fold greater likelihood of having asthma, such that 1/3 children with stones under the age of 12 have asthma. The data suggests a mechanistic link between asthma and nephrolithiasis. Further investigation is needed to elucidate the pathophysiologic origin of this relationship.