Kidney Week

Abstract: FR-PO238

Cholecystectomy Association with Kidney Stone Occurrence

Session Information

• Mineral Bone Disease: Transplant and Kidney Stones
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Zaidan, Nadim, Staten Island University Hospital, Staten Island, New York, United States

Nadim Zaidan, MD

• Araji, Hachem, Staten Island University Hospital, Staten Island, New York, United States

Hachem Araji, MD

• Habib, Toni, Staten Island University Hospital, Staten Island, New York, United States

Toni Habib, MD

• El Gharib, Khalil, Staten Island University Hospital, Staten Island, New York, United States

Khalil El Gharib, MD

• Bonifant, George C., Staten Island University Hospital, Staten Island, New York, United States

George C. Bonifant, MD

• El-Charabaty, Elie, Staten Island University Hospital, Staten Island, New York, United States

Elie El-Charabaty, MD, FASN

• El Sayegh, Suzanne E., Staten Island University Hospital, Staten Island, New York, United States

Suzanne E. El Sayegh, MD, FASN

Background

Patients with steatorrhea are at increased risk of calculi formation. For instance, malabsorptive bariatric surgery leads to steatorrhea and calcium chelation, which contributes to higher oxalate bioavailability and enteric hyperoxaluria. A disruption of the biliary acid cycle has been described after cholecystectomy which could lead to altered lipid digestion and subsequently increased oxalate reabsorption. We hypothesize that this potential post-surgical bile acid malabsorption could be associated with the occurrence of nephrolithiasis.

Methods

We used the National Inpatient Database (NIS), between 2016 and 2020, to identify patients with diagnoses of urinary tract calculus (CCSR: GEN005) and cholecystectomy (CCSR: HEP006) through the appropriate ICD-10 codes. Only adult patients (>18 years) with identifiable body mass indices (BMI) levels were included in the study. Binary logistic regression was performed to assess whether cholecystectomy was independently associated with nephrolithiasis, while adjusting for basic demographic covariates and known risk factors for kidney stone formations. All statistical analyses were performed using the SAS software.

Results

A total of 5 646 289 patients were included in the final cohort, 1.56% of which had undergone cholecystectomy. 56 234 patients had a diagnosis of kidney or urinary tract calculus, with a mean age of 60.39 years and a female predominance (53.60%). Cholecystectomy was found to be independently associated with the occurrence of calculi (Chi-Square = 51.96; p-value < 0.0001). After adjusting for demographic covariates (age, sex, race, geographic location, payer type, income level) and medical comorbidities (diabetes mellitus, gout, alcohol use, tobacco use, BMI), we found an odds ratio of 1.223 [1.151 – 1.299] of urinary tract calculi in patients that underwent this surgery compared with patients that still had their gallbladder, which indicates an 18.23% percentage increase in risk.

Conclusion

The association between cholecystectomy and urinary tract calculus and the percentage increase in risk in patients that underwent the surgery highlights the underappreciated impact of bile acid physiology on lipid digestion and its potential link with kidney stone disease. Further analysis involving prospective cohorts will be necessary to confirm and better elucidate this association.