#0372

Increased Risk of Urolithiasis in Patients with Primary Aldosteronism: A Large-Scale Retrospective Cohort Study

M. Leong¹, H. Lee¹, S. Wang², Y. Juan¹, C. Chang¹, S. Cho³, W. Wu¹, W. Li¹

¹Kaohsiung Medical University Hospital, Urology, Kaohsiung, Taiwan
²Chung Shan Medical University Hospital, Medical Research, Taichung, Taiwan
³Seoul National University Hospital, Urology, Seoul, Korea (Republic of)

Introduction:

Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with various metabolic disturbances, including calcium metabolism disorders and acid-base imbalances. Emerging evidence suggests a potential link between PA and urolithiasis; however, previous studies have been limited by small sample sizes and inconsistent findings. This study aims to investigate the association between PA and urinary stone formation using a large-scale real-world dataset.

Material and methods:

We conducted a retrospective cohort study using the TriNetX database, which includes de-identified electronic health records from over 250 million individuals. Patients diagnosed with PA were identified based on ICD-10-CM and ICD-9-CM codes, and a propensity score-matched (PSM) cohort of PA and non-PA patients with essential hypertension was created. The primary outcome was the incidence of urolithiasis (kidney and urinary tract stones), identified using ICD-10-CM codes (N20-N23). Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analyses were conducted based on sex, metabolic disorders, and renal function (eGFR ≥60 vs. <60 mL/min/1.73 m²).

Results:

A total of 10,578 PA patients and 7,897,605 non-PA patients were identified, with 10,577 matched pairs included in the final analysis after 1:1 propensity score matching. PA was associated with a significantly higher risk of urolithiasis compared to non-PA patients at 1-year (HR: 1.524, 95% CI: 1.238-1.877), 3-year (HR: 1.312, 95% CI: 1.120-1.537), 5-year (HR: 1.303, 95% CI: 1.130-1.502), and 7-year (HR: 1.269, 95% CI: 1.107-1.456) follow-ups. Subgroup analyses revealed that the increased risk of urolithiasis persisted across both sexes and was more pronounced in patients without metabolic disorders (HR: 1.826, 95% CI: 1.452-2.295) and those with preserved renal function (eGFR ≥60 mL/min/1.73 m², HR: 1.269, 95% CI: 1.072-1.502).