Denburg MR et al, 2015: Assessing the risk of incident hypertension and chronic kidney disease after exposure to shockwave lithotripsy and ureteroscopy.
Denburg MR, Jemielita TO, Tasian GE, Haynes K, Mucksavage P, Shults J, Copelovitch L.
The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
In this study we sought to determine if among individuals with urolithiasis, extracorporeal shock wave lithotripsy (SWL) and ureteroscopy are associated with a higher risk of incident arterial hypertension (HTN) and/or chronic kidney disease (CKD). This was measured in a population-based retrospective study of 11,570 participants with incident urolithiasis and 127,464 without urolithiasis in The Health Improvement Network. Patients with pre-existing HTN and CKD were excluded. The study included 1319 and 919 urolithiasis patients with at least one SWL or URS procedure, respectively. Multivariable Cox regression was used to estimate the hazard ratio for incident CKD stage 3-5 and HTN in separate analyses. Over a median of 3.7 and 4.1 years, 1423 and 595 of urolithiasis participants developed HTN and CKD, respectively. Urolithiasis was associated with a significant hazard ratio each for HTN of 1.42 (95% CI: 1.35, 1.51) and for CKD of 1.82 (1.67, 1.98). SWL was associated with a significant increased risk of HTN 1.34 (1.15, 1.57), while ureteroscopy was not. When further stratified as SWL to the kidney or ureter, only SWL to the kidney was significantly and independently associated with HTN 1.40 (1.19, 1.66). Neither SWL nor ureteroscopy was associated with incident CKD. Since urolithiasis itself was associated with a hazard ratio of 1.42 for HTN, an individual who undergoes SWL to the kidney can be expected to have a significantly increased hazard ratio for HTN of 1.96 (1.67, 2.29) compared with an individual without urolithiasis.
Kidney Int. 2015 Oct 28.doi: 10.1038/ki.2015.321. [Epub ahead of print]
Hypertension after ESWL is back again - this time based on population statistics. Papers like this have to be red with some caution. Not a single blood pressure was measured by the authors. The data are exclusively based on coding statistics and the way practitioners code diseases and co-morbidities of their patients sometimes depends on coding habits and arithmetic’s rather than the actual patient’s conditions. But the fact that only EWSL on the kidney and not on the ureter was related to an increased blood pressure seems to suggest a causal relation. Based on the data presented, of 100 stone patients 15 with ESWL on kidney stones and 12 without ESWL will develop hypertension. The difference is not big. Urologists should primarily focus on a causal therapy of stone disease.