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. 2022 Jun:164:74-79.
doi: 10.1016/j.urology.2021.12.037. Epub 2022 Feb 17.

Comparison of Selective vs Empiric Pharmacologic Preventive Therapy of Kidney Stone Recurrence With High-Risk Features

Ryan S Hsi  1 , Phyllis L Yan  2 , Joseph J Crivelli  3 , David S Goldfarb  4 , Vahakn Shahinian  2 , John M Hollingsworth  5
Affiliations

Comparison of Selective vs Empiric Pharmacologic Preventive Therapy of Kidney Stone Recurrence With High-Risk Features

Ryan S Hsi et al. Urology. 2022 Jun.

Abstract

Objective: To compare the frequency of stone-related events among subgroups of high-risk patients with and without 24-hour urine testing before preventive pharmacological therapy (PPT) prescription. While recent studies show, on average, no benefit to a selective approach to PPT for urinary stone disease (USD), there could be heterogeneity in treatment effect across patient subgroups.

Materials and methods: Using medical claims data from working-age adults and their dependents with USD (2008-2019), we identified those with a prescription fill for a PPT agent (thiazide diuretic, alkali therapy, or allopurinol). We then stratified patients into subgroups based on the presence of a concomitant condition or other factors that raised their stone recurrence risk. Finally, we fit multivariable regression models to measure the association between stone-related events (emergency department visit, hospitalization, and surgery) and 24-hour urine testing before PPT prescription by high-risk subgroup.

Results: Overall, 8369 adults with USD had a concomitant condition that raised their recurrence risk. Thirty-three percent (n = 2722) of these patients were prescribed PPT after 24-hour urine testing (median follow-up, 590 days), and 67% (n = 5647) received PPT empirically (median follow-up, 533 days). Compared to patients treated empirically, those with a history of recurrent USD had a significantly lower hazard of a subsequent stone-related event if they received selective PPT (hazard ratio, 0.83; 95% confidence interval, 0.71-0.96). No significant associations were noted for selective PPT in the other high-risk subgroups.

Conclusion: Patients with a history of recurrent USD benefit from PPT when guided by findings from 24-hour urine testing.

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Figures

Figure 1.
Figure 1.
Flowchart for cohort selection
Figure 2.
Figure 2.
Adjusted rates of symptomatic stone recurrence over 2 years comparing selective versus empiric pharmacologic preventative therapy among patients with recurrent kidney stones
See this image and copyright information in PMC

Comment in

References

    1. Song S, Thomas I-C, Ganesan C, et al.: Twenty-Four Hour Urine Testing and Prescriptions for Urinary Stone Disease-Related Medications in Veterans. Clin J Am Soc Nephrol 2019; 14: 1773–1780. - PMC - PubMed
    1. Pearle MS, Goldfarb DS, Assimos DG, et al.: Medical management of kidney stones: AUA guideline. J Urol 2014; 192: 316–24. - PubMed
    1. Skolarikos A, Straub M, Knoll T, et al.: Metabolic evaluation and recurrence prevention for urinary stone patients: EAU guidelines. Eur Urol 2015; 67: 750–63. - PubMed
    1. Gambaro G, Croppi E, Coe F, et al.: Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 2016; 29: 715–734. - PMC - PubMed
    1. Goldfarb DS: Empiric therapy for kidney stones. Urolithiasis 2018. - PMC - PubMed

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