Association of Prevalent Kidney Stone Disease With All-Cause Mortality Among U.S. Adults: The National Health and Nutrition Examination Survey 2007 to 2018

Background: Kidney stone disease (KSD) has been associated with multiple risk factors that increase mortality, but a direct association has not been shown between KSD and survival. Previously, we have reported survival data from 1988 to 1994 among stone formers from US adults. Now, we report all-cause mortality in prevalent KSD using both National Health and Nutrition Examination Survey (NHANES) III and the updated 2007 to 2018 cohort. Methods: We examined the relationship between KSD and risk of death among a nationally representative sample of US adults (age ≥20 years) using both NHANES cohorts and the linked mortality data. Cox proportional hazard regression analyses were used to estimate the risks of all-cause deaths. Results: In total, 27,284 participants were eligible for the final analysis including 2634 prevalent kidney stone (KS) formers. Stone formers tended to be non-Hispanic, White men, who had a higher BMI, and were more likely to have hypertension, diabetes, and cardiovascular disease (CVD). There was a total of 2374 all-cause deaths. Unadjusted analysis showed that stone formers had a higher risk of death from all-causes (hazard ratio [HR] 1.63, 95% confidence interval [CI]: 1.38-1.93, P < .001). However, after multivariable adjustment, stone formers no longer had an increased risk of death from all-causes compared with nonstone formers (HR 0.90, 95% CI: 0.76-1.05, P = .18). Conclusions: Using the updated NHANES 2007 to 2018 cohort, prevalent KSD again has no direct correlation with all-cause mortality, independent of CVD and its traditional risk factors. Further studies from other KS populations are needed to confirm this finding.