Urinary stone disease is a prevalent condition associated with a high recurrence risk. Preventive pharmacological therapy has been proposed to reduce recurrent stone episodes. However, limited evidence exists regarding its effectiveness, contributing to its underutilization by physicians. This study aimed to evaluate the association between preventive pharmacological therapy (thiazide diuretics, alkali therapy, and uric acid lowering medications) and clinically significant urinary stone disease recurrence.
Using data from the Veterans Health Administration, adults with an index episode of urinary stone disease from 2012 through 2019 and at least one urinary abnormality (hypercalciuria, hypocitraturia, or hyperuricosuria) on 24-hour urine collection were included. The primary outcome was a composite variable representing recurrent stone events that resulted in emergency department visits, hospitalizations, or surgery for urinary stone disease. Cox proportional hazards regression was performed to estimate the association between preventive pharmacological therapy use and recurrent urinary stone disease while adjusting for relevant baseline patient characteristics.
Among the cohort of patients with urinary abnormalities (n=5,637), treatment with PPT was associated with a significant 19% lower risk of recurrent urinary stone disease during the 12-36-month period following the initial urine collection (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.65-1.00, p = 0.0496. However, the effectiveness of preventive pharmacological therapy diminished over longer follow-up periods (12-48 months and 12-60 months following the urine collection) and did not reach statistical significance. When examining specific urinary abnormalities, only alkali therapy for hypocitraturia was associated with a significant 26% lower recurrence risk within the 12-36-month timeframe (HR 0.74, 95%CI 0.56-0.97, p=0.03).
When considering all urinary abnormalities together, this study demonstrates that use of preventive pharmacological therapy is associated with a lower risk of clinically significant recurrent episodes of urinary stone disease in the 12-36 month timeframe following urine collection, though only the association with use of alkali therapy for hypocitraturia was significant when individual abnormalities were examined.
Clinical journal of the American Society of Nephrology : CJASN. 2024 Feb 12 [Epub ahead of print]
Kumaran Arivoli, Autumn N Valicevic, Mary K Oerline, Ryan S Hsi, Sanjeevkumar R Patel, John M Hollingsworth, Vahakn B Shahinian
University of Michigan School of Medicine, Ann Arbor, MI., Veterans Administration, Veterans Affairs Medical Center, Ann Arbor, MI., Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, Vanderbilt University Medical Center, Nashville, TN., Department of Urology, NorthShore University Health System, Evanston, IL.