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Abstract: PO0606

Association Between 24-Hour Urine Sodium or Potassium Excretion and Cardiovascular Events in Veterans with Urinary Stone Disease

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Romero, Ruth Yolanda, Stanford Health Care, Stanford, California, United States
  • Ganesan, Calyani, Stanford Health Care, Stanford, California, United States
  • Thomas, I-Chun, VA Palo Alto Health Care System, Palo Alto, California, United States
  • Chertow, Glenn Matthew, Stanford Health Care, Stanford, California, United States
  • Leppert, John, Stanford Health Care, Stanford, California, United States
  • Pao, Alan C., Stanford Health Care, Stanford, California, United States
Background

Urinary stone disease (USD) is associated with an increased risk of major adverse cardiovascular events. Recent studies that estimated 24-hour urine excretion from spot urine samples have demonstrated that high urine sodium excretion and low urine potassium excretion are independently associated with cardiovascular events. Since patients with USD undergo 24-hour urine testing for stone prevention, direct 24-hour urine testing for sodium and potassium excretion may provide insight into cardiovascular risk for patients with USD.

Methods

We identified 6,401 Veterans with USD and a 24-hour urine sodium measurement and 4,950 Veterans with USD and a 24-hour urine potassium measurement between 2007 and 2015 from national VHA data. We defined the primary outcome as an inpatient or emergency department diagnosis of acute myocardial infarction, unstable angina or stroke or a procedural code for percutaneous coronary intervention or coronary artery bypass graft surgery. We performed Cox proportional hazards regression to identify the risk of a cardiovascular event by level of 24-hour urine sodium and/or potassium excretion.

Results

Among the 6,401 Veterans with USD and a 24-hour urine sodium measurement, 715 (11.2%) had a major cardiovascular event. Veterans with a 24-hour urine sodium in the lowest 10th percentile (<113 mEq/day) had a higher risk of a cardiovascular event compared to those with a 24-hour urine sodium between the 10th and 90th percentile (HR 1.55, CI 1.25-1.92). We found no significant association between 24-hour urine potassium excretion and cardiovascular events.

Conclusion

Patients with lower 24-hour urine sodium excretion have a higher risk for cardiovascular events. Patients with higher 24-hour urine sodium excretion or lower 24-hour urine potassium excretion do not have a higher risk of cardiovascular events. These findings differ prior studies that used spot urine samples to identify patients who are at risk for cardiovascular disease, suggesting that direct measurement of 24-hour urine sodium or potassium excretion more accurately identifies patients who are at risk for cardiovascular disease.