The aim of the study was to establish reference intervals for 24-h urinary stone risk factors in the healthy Chinese Han population.
From May 2013 to July 2014, we collected and analyzed 24-h urine samples from healthy adult Han population during a cross-sectional study across China. The protocol for analysis of 24-h urine included volume, pH, oxalate, citrate, sodium, potassium, chloride, calcium, phosphorous, creatinine, urate, magnesium, the ion activity products of calcium oxalate (AP(CaOx) indexs) and calcium phosphate (AP(CaP) indexs). We calculated the reference intervals according to the Clinical and Laboratory Standards Institute (CLSI) 2008 guidelines and compared them with those recorded in other studies.
A total of 132 male and 123 female healthy subjects with a mean (SD, range) age of 52.4 (15.2, 19–89) years were eligible in the final analysis. Men had higher 24-h excretion of creatinine, calcium, urate and phosphorus and lower levels of citrate, magnesium, chloride, sodium and potassium than women. AP(CaOx) indexs and AP(CaP) indexs were significantly higher among men than women. When urinary findings were compared with the reference intervals, most of our data showed a high abnormality rate, especially for creatinine, calcium, citrate, magnesium, chloride, sodium and potassium.
The present study revealed the normal metabolic status for stone risk factors of the Chinese Han population. It is therefore necessary for each country or region to define their own reference intervals for comparison of stone risk factors between patients and healthy subjects.
We are grateful to Hans-Göran Tiselius, for his help in revising the manuscript.
Author contributions: Zanlin Mai, Xiaoxia Li, Zelin Cui, Wenqi Wu and Yongda Liu have made identical contributions to this study as the co-first authors. Guohua Zeng conceived, designed and organized this study, interpreted the results and revised the manuscript. All authors contributed to collect the data. Zanlin Mai and Xiaoxia Li analyzed the data. Zanlin Mai wrote the first draft of the manuscript. Guohua Zeng and Wenqi Wu obtained funding. Guohua Zeng is the corresponding author. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This work was financed by grants from National Natural Science Foundation of China (no. 81370804, no. 81570633 and no. 81670643), the Science and Technology Project in Guangdong, China (no. 2014A020209085) and Guangzhou Science Technology and Innovation Commission (no. 201604020001 and no. 201704020193).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organizations played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
1. Hesse A, Brändle E, Wilbert D, Köhrmann KU, Alken P. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs.2000. Eur Urol 2003;44:709–13.10.1016/S0302-2838(03)00415-9Search in Google Scholar
5. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12:e86–96.Search in Google Scholar
6. Zeng G, Mai Z, Xia S, Wang Z, Zhang K, Wang L, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int 2017;120:109–16.10.1111/bju.13828Search in Google Scholar PubMed
10. CLSI. Defining, establishing, and verifying reference intervals in the clinical laboratory; Approved Guideline—Third Edition. CLSI document C28-A3. Wayne, PA: Clinical and Laboratory Standards Institute, 2008.Search in Google Scholar
13. Curcio R, Stettler H, Suter PM, Aksozen JB, Saleh L, Spanaus K, et al. Reference intervals for 24 laboratory parameters determined in 24-hour urine collections. Clin Chem Lab Med 2016;54:105–16.10.1515/cclm-2014-1041Search in Google Scholar PubMed
14. Coe FL, Favus MJ, Crockett T, Strauss AL, Parks JH, Porat A, et al. Effects of low-calcium diet on urine calcium excretion, parathyroid function and serum1,25(OH)2D3 levels in patients with idiopathic hypercalciuria and in normal subjects. Am J Med 1982;72:25–32.10.1016/0002-9343(82)90567-8Search in Google Scholar
15. Ichihara K, Itoh Y, Min WK, Yap SF, Lam CW, Kong XT, et al. Diagnostic and epidemiological implications of regional differences in serum concentrations of proteins observed in six Asian cities. Clin Chem Lab Med 2004;42:800–9.10.1515/CCLM.2004.133Search in Google Scholar
16. Mente A, Honey RJ, Mclaughlin JR, Bull SB, Logan AG. Ethnic differences in relative risk of idiopathic calcium nephrolithiasis in North America. J Urol 2007;178:1992–7.10.1016/j.juro.2007.07.024Search in Google Scholar
17. Zhu W, Mai Z, Qin J, Duan XL, Liu Y, Zhao ZJ, et al. Difference in 24-hour urine composition between diabetic and non-diabetic adults without nephrolithiasis. PLoS One 2016;11:e0150006.10.1371/journal.pone.0150006Search in Google Scholar
21. Lin PH, Ginty F, Appel LJ, Aickin M, Bohannon A, Garnero P, et al. The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 2003;133:3130–610.1093/jn/133.10.3130Search in Google Scholar PubMed
22. James TP, Rigby N, Leach R. The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J Cardiovasc Prev Rehabil 2004;11:3–8.10.1097/01.hjr.0000114707.27531.48Search in Google Scholar PubMed
23. Wu AH, editor. Tietz clinical guide to laboratory tests, 4th ed. St. Louis, MO: Saunders Elsevier, 2006.Search in Google Scholar
24. Zuckerman JM, Assimos DG. Hypocitraturia: pathophysiology and medical management. Rev Urol 2009;11:134–44.Search in Google Scholar
26. Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G, et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney Int 2004;66:2402–10.10.1111/j.1523-1755.2004.66029.xSearch in Google Scholar
27. Sebastian A, Frassetto LA, Morris RC Jr. The acid-base effects of the contemporary Western diet: an evolutionary perspective. In: Alpern RJ, Hebert SC, editors. Seldin and Giebisch’s The Kidney: physiology & pathophysiology, 4th ed. Amsterdam: Elsevier Inc., 2008:1621–44.10.1016/B978-012088488-9.50060-7Search in Google Scholar
28. Mandel EI, Taylor EN, Curhan GC. Dietary and lifestyle factors and medical conditions associated with urinary citrate excretion. Clin J Am Soc Nephrol 2013;8:901–8.10.2215/CJN.07190712Search in Google Scholar
29. Zhai F, Wang H, Du S, He Y, Wang Z, Ge K, et al. Lifespan nutrition and changing socio-economic conditions in China. Asia Pac J Clin Nutr 2007;16 Suppl:S374–82.Search in Google Scholar
31. Rude RK. Magnesium. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, editors. Modern nutrition in health and disease, 11th ed. Baltimore, MA: Lippincott Williams & ilkins, 2012:159–75.Search in Google Scholar
32. Classen HG, Nowitzki S. The clinical importance of magnesium. 2. The indications for supplementation and therapy. Fortschr Med 1990;10:198–200.Search in Google Scholar
33. Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R. What we eat in America, NHANES 2005–2006: usual nutrient intakes from food and water compared to 1997 Dietary Reference Intakes for Vitamin D, Calcium, Phosphorus, and Magnesium; U.S. Department of Agriculture, Agricultural Research Service: Washington, DC, USA, 2009. Nutrients 2015;7:8218.Search in Google Scholar
34. Shah NC, Shah JG, Li Z, Jiang XC, Altura BT, Altura BM. Short-term magnesium deficiency downregulates telomerase, upregulates neutral sphingomyelinase and induces oxidative DNA damage in cardiovascular tissues: relevance to atherogenesis, cardiovascular diseases and aging. Int J Clin Exp Med 2014;7:497–514.Search in Google Scholar
37. Burtis WJ, Gay L, Insogna KL, Ellison A, Broadus AE. Dietary hypercalciuria in patients with calcium oxalate kidney stones. Am J Clin Nutr 1994;60:424–9.10.1093/ajcn/60.3.424Search in Google Scholar
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-0401).
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