Assessing the Risk of Kidney Stone Development in Patients with Idiopathic Intracranial Hypertension Treated with Carbonic Anhydrase Inhibitors

Background:The prevalence of idiopathic intracranial hypertension (IIH) is rising with the global obesity epidemic. Carbonic anhydrase inhibitors (CAIs), such as acetazolamide, have been shown to be effective in IIH but can also lead to kidney stone formation. This study evaluates the risk of kidney stone development in patients with IIH treated with CAIs.Methods:A retrospective cohort study using the TriNetX database was performed to compare patients with IIH treated with CAIs vs. untreated controls. Propensity score matching (PSM) balanced demographic and clinical variables. The primary outcome was kidney stone incidence for 3 time intervals: 1 year, 1-2 years, and 2-3 years, identified using International Classification of Diseases-10 codes. Risk ratios (RRs) with 95% confidence intervals (CIs) assessed the association between CAI treatment and kidney stone formation.Results:The study evaluated 23,182 patients with IIH treated with CAIs compared with 50,080 untreated controls. After applying PSM, each group was balanced to include 22,464 patients. The treated group had a significantly higher risk of developing kidney stones than the control group, with an RR of 1.49 (95% CI: 1.22-1.84) at 1 year, 2.24 (95% CI: 1.61-3.12) at 1-2 years, and 1.51 (95% CI: 1.05-2.18) at 2-3 years. Sensitivity analysis of patients treated with at least 500 mg of acetazolamide shared this elevated trend, and the risk remained persistently high at 2-3 years (RR: 2.18, 95% CI: 1.13-4.20). Subgroup analysis revealed higher risks in males, while Black or African American patients had a lower risk.Conclusions:Carbonic anhydrase inhibitor use in patients with IIH may increase kidney stone risk, particularly in certain populations. Further research is needed to understand the mechanisms behind this risk and to optimize treatment strategies.