Urological procedures in urolithiasis and their association with chronic kidney disease

Background and Objectives: Epidemiological evidence suggests that patients with urolithiasis are at increased risk for end-stage renal disease (ESRD). It is unclear if urological intervention impacts the progression of chronic kidney disease (CKD). Methods: We conducted a retrospective observational cohort study of patients in the Marshfield Epidemiologic Study Area database between January 1991 and May 2007, where 1,340 patients diagnosed with urolithiasis were extracted. Of the 1,340 subjects, 446 had urological procedures for management of urolithiasis. Those that underwent these procedures were compared to those that did not. Cox proportional hazards models adjusted for age, gender, and comorbidities were performed to evaluate the risk for CKD, elevated serum creatinine, and any-cause mortality. Results: Baseline comorbidities in patients with and without procedures were not significantly different except for obesity (P<0.0001). Subjects that underwent procedures were at increased risk for elevated serum creatinine (Hazard Ratio (HR) [95% CI] =1.49 [1.19-1.85]) when compared to those that did not undergo a urologic procedure during the study period. The results did not reveal a significant difference in incidence of CKD or any-cause mortality. Conclusions: Patients who undergo urologic procedures are at increased risk for elevated creatinine. Urological procedures do not appear to impact incidence of CKD or mortality and, in fact, may prevent long-term renal dysfunction.