Cystic Fibrosis linked to high Lifetime Risk of Nephrolithiasis, suggests study
A new study published in the journal of Plos One showed that over the course of their lives, about one in three people with cystic fibrosis (CF) develop nephrolithiasis. The occurrence of kidney stones was not related to the level of control of exocrine pancreatic insufficiency.
About 5% of patients with cystic fibrosis have nephrolithiasis, while rates can reach 20% in some cohorts. Nephrolithiasis is linked to a high likelihood of recurrence and surgical intervention. Due to enteric hyperoxaluria, calcium oxalate stones almost exclusively develop in people with EPI. Nephrolithiasis and the level of EPI control, however, have not been evaluated. Thus, this study assessed the risk of nephrolithiasis based on the level of EPI control in CF.
All persons living with cystic fibrosis (PwCF) observed in the institution between 2018 and 2023 (n = 332) were included in a retrospective cohort analysis. Socio-demographics, Charlson comorbidity index, exocrine pancreatic insufficiency (EPI) control status determined by treating physicians (classified as controlled, uncontrolled, or unknown), and nephrolithiasis events were among the data collected. The total sample's incidence and lifetime prevalence rates were computed using EPI control. Likelihood-ratio-based backwards stepwise selection was used to create a multivariable logistic regression model for the nephrolithiasis outcome.
In this study cohort, the cumulative lifetime prevalence of any nephrolithiasis episode was 32%. There was no discernible difference in lifetime prevalence based on EPI control status, however it was greater in EPI (32%) than in no EPI (24%). Small bowel resection (odds ratio [OR] 3.0, 95% confidence interval (CI) 1.0–9.0), alcohol use (OR 1.7, 95% CI 1.0–2.9), and lower BMI (OR 0.9, 95% CI 0.9–1.0) were found to be independently linked to nephrolithiasis by the multivariable model.
51% (n = 54) of the 105 people with nephrolithiasis experienced repeated episodes. 10% (n = 3) of patients with a single nephrolithiasis incident needed an invasive procedure, whereas 61% (n = 33) of patients with recurrent nephrolithiasis needed one.
Overall, in PwCF, nephrolithiasis episodes are frequent. Although this may be constrained by relying on clinician evaluation of EPI control rather than a more objective metric, this research observed a greater prevalence among PwCF with EPI but did not see a difference dependent on the degree of EPI control.
Reference:
Ryoo, D. Y., Ladd, N., Culp, S., Harris, S., Murray, G., McGuinness, M., Kirkby, S. E., Shidham, G., Rice, A., Roberts, K. M., Papachristou, G. I., Hart, P. A., & Ramsey, M. L. (2026). Prevalence and risk factors for nephrolithiasis in adults with cystic fibrosis: A retrospective cohort study. PloS One, 21(1), e0340293. https://doi.org/10.1371/journal.pone.0340293
