To characterize the changes in urine composition associated with increasing severity of diabetes, we analyzed urine composition relative to HbA1c and treatment strategy in a largely minority population.
All patients that were treated for kidney stones between 2001 and 2013 at a single tertiary institution, and had 24-hour urine collections. Patients with type I diabetes or taking either thiazide diuretics or alkanalizing agents were excluded. Analysis was performed in SPSS version 20 using multivariate regression, and Kruskall-Wallis testing.
955 patient were included in this study, 268 (28%) with type II diabetes mellitus, of whom 53 (19. 8%) used insulin. Patients with diabetes had lower urine pH, calcium, and phosphate when compared to the control group, but no significant differences were found between the diabetes groups. Multivariate analysis found that HbA1c had a positive correlation with citrate (p = 0. 008), creatinine (p = 0. 037), urine volume (p = 0. 044), and a trend towards calcium (p=0. 064). Insulin use did not have a significant relationship with urinary parameters, but trended towards an inverse relationship with calcium (p=0. 051). pH was not a significant predictor of any urine constituent.
In an ethnically diverse inner city patient population, patients with DM2 who use insulin have no significant differences in urine parameters when compared to those on oral hypoglycemics. Worsening glucose control as measured by HbA1c levels predicts increased urine citrate and volume.
Urology. 2015 Oct 22 [Epub ahead of print]
Ethan B Fram, Saman Moazami, Joshua M Stern
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. , Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.