The impact of bilateral stone disease on patients’ disease progression and quality of life
Brendan Lapointe Raizenne1, Claudia Deyirmendjian2, Maimouna Balde3, Seth K. Bechis4, Roger L. Sur4, Stephen Y. Nakada5, Jodi A. Antonelli6, Necole M. Streeper7, Sri Sivalingam8, Davis P. Viprakasit9, Timothy D. Averch10, Thomas Chi11, Kristina L. Penniston5, Naeem Bhojani1.
1Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; 2Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 3Faculty of Sciences and Technologies, Gaston Berger University, Saint Louis, Senegal; 4Department of Urology, University of California San Diego, San Diego, CA, United States; 5Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; 6Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States; 7Division of Urology, Pennsylvania State University College of Medicine, Hershey, PA, United States; 8Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States; 9Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, United States; 10Department of Urology, Palmetto Health USC Medical Group, Columbia, SC, United States; 11Department of Urology, University of California San Francisco, San Francisco, CA, United States
Introduction: Kidney stone disease is associated with significant morbidity and functional impairment. Few studies have examined the impact of bilateral kidney stones on disease progression. We sought to determine the impact of bilateral stone disease on age of onset, number of stone events, and individual patient Health-Related Quality of Life (HRQOL) by querying the validated and prospectively collected Wisconsin Stone Quality of Life (WISQOL) database.
Methods: Cross-sectional data were obtained from 2906 kidney stone formers from 14 institutions in North America who completed the WISQOL questionnaire from 2014–2019. The 28-question survey has a 1–5-point scale for each item (total score range 0–140). Kidney stone formers were further stratified according to the presence of bilateral or unilateral kidney stones. Categorical variables were reported and compared using a Chi-squared test. A multivariable linear regression model assessed the impact of bilateral kidney stone disease on HRQOL.
Results: Of 2906 kidney stone formers, 1340 had unilateral kidney stones and 1566 had bilateral kidney stones. Bilateral kidney stone formers had a younger mean (standard deviation) age of kidney stone onset (37.2±15.8 vs. 46.4±15.9 years of age, p<0.001). Bilateral kidney stone formers had a higher number of stone events than unilateral kidney stone formers (p<0.001). Bilateral kidney stone formers had a higher mean (standard deviation) number of comorbidities (2.02±1.82 vs. 1.87±1.77, p<0.05). Among those comorbidities, bilateral kidney stone disease was associated with an increased number of depression/anxiety symptoms (350, [22.4%] vs. 247 [18.4%], p<0.05). Bilateral and unilateral kidney stone formers did not differ for calcium oxalate, calcium phosphate, uric acid, and mixed stone composition (p>0.05). On multivariable analysis, bilateral kidney stone disease was an independent predictor of worse HRQOL (β=-11.2, confidence interval -19.5 to -3.0 points, p<0.05).
Conclusions: Bilateral kidney stone formers had a younger age of kidney stone onset and a higher number of stone events than unilateral kidney stone formers. The presence of bilateral kidney stones negatively impacted HRQOL. Therefore, clinicians should pay closer attention to bilateral kidney stone patients on clinical presentation and their risk for disease progression.
