Surgical interventions for nephrolithiasis in ankylosing spondylitis and the general population

Abstract

Objective. The aim of this study was to estimate rates and type of definitive surgical interventions for nephrolithiasis in Swedish patients with ankylosing spondylitis (AS) compared to the general population. Materials and methods. This national prospective cohort study linked data from Swedish population and healthcare registries. Incidence rates and interventions for nephrolithiasis during follow-up in patients with AS were compared to general population comparator (GPC) subjects. Results. In total, 8572 AS patients were followed for 49,959 person-years and 39,639 matched GPCs were followed for 225,221 person-years. Mean age at study entry was 46 years [interquartile range (IQR) 36–56 years] and 65% were male. In AS patients with a diagnosis of nephrolithiasis during the study period, 29% (72/250) underwent similar intervention for nephrolithiasis compared to 24% (114/466) GPCs (p = 0.21). The incidence rate ratio (RR) in overall AS patients was 2.9 [95% confidence interval (CI) 2.1–3.8] during a median follow-up of 6.2 years (IQR 3.2–8.6 years). With prior diagnosis of nephrolithiasis, the RR for AS patients compared to GPCs was 3.7 (95% CI 1.8–7.7); without prior nephrolithiasis the RR was 2.1 (95% CI 1.5–3.0). Increasing age [odds ratio (OR) 1.02, 95% CI 1.01–1.03], prior nephrolithiasis diagnosis (OR 3.3, 95% CI 1.97–5.62) and atherosclerotic cardiac disease (OR 2.0, 95% CI 1.03–3.91) were identified as predictors of intervention for nephrolithiasis. Conclusions. Patients with AS have an almost three-fold increased risk of surgical intervention for kidney stones, with similar management, compared to the general population.

Keywords: :

• Ankylosing spondylitis
• comparative study
• lithotripsy
• nephrolithiasis
• percutaneous nephrolithotomy
• ureteroscopy

Acknowledgements

We are indebted to all colleagues and staff at our university departments, especially Pernilla Nilsson and Jonas Ericsson. Author contribution: AKJ and LEK (guarantor) conceived the idea and designed the study in collaboration with LTHJ, OP, TH and JA. LEK, JA and LTHJ conducted the collection and linkage of register data. AKJ and LEK performed the analysis. AKJ drafted the paper. All authors had full access to all data at all time of the manuscript planning, drafting and post submission. All authors contributed to the interpretation of the results and editing of the manuscript, and read and approved the final manuscript.

Funding: This study was supported by grants from the Oak Foundation, the Skane Region, Lunds University, and Reumatikerförbundet, the Swedish Foundation for Strategic Research.

Declaration of interest: AKJ affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and no significant discrepancies from the study protocol as planned were encountered. No potential conflict of interest was reported by the authors.

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