Physical frailty increases the risk for urinary tract stones in patients with diabetes mellitus, a population already shown to be at elevated risk for urolithiasis, according to a new report. The finding suggests that interventions to ameliorate frailty in diabetics could decrease their risk of urolithiasis.

Using data from Taiwan’s Longitudinal Cohort of Diabetes Patients from 2004 to 2010, Chia-Ter Chao, MD, of National Taiwan University Hospital Beihu Branch, Taipei, and colleagues studied 525,368 patients with diabetes mellitus: 338,121 (64.4%) without frailty and 187,247 (35.6%) with frailty as defined using the FRAIL scale. The scale includes 5 self-reported items: fatigue, resistance, ambulation, illness, and loss of weight. Of the frail patients, 149,748 (28.5%), 34,463 (6.6%), and 3036 (0.6%) had 1, 2, and 3 or more FRAIL items at baseline.

At least 1 episode of incident urolithiasis—most commonly renal stones—developed in 18,034 patients (3.4%) after 4.2 years of follow-up. Compared with non-frail patients, those who reported 2 items and 3 or more items on the FRAIL scale had significant 23% and 46% increased risks for urinary tract stones, respectively, in adjusted analyses, the investigators reported in BMJ Open Diabetes Research & Care. Patients who reported only 1 FRAIL item had a nonsignificant 4% increased risk of urolithiasis.

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“The assessment of frailty can assist in estimating the risk of urolithiasis among patients with diabetes,” the investigators wrote. “There is a probability that interventions directed toward frailty can ameliorate the risk of developing urolithiasis among patients with diabetes.”


Chao CT, Wang J, Huang JW, et al. Fraily predicts a higher risk of incident urolithiasis in 525 368 patients with diabetes mellitus: a population-based study. BMJ Open Diabetes Res Care. 2020;8:e000755. doi: 10.1136/bmjdrc-2019-000755