Comparison of Selective Versus Empiric Pharmacologic Preventative Therapy With Kidney Stone Recurrence.
Objective: To assess the effectiveness of an empiric approach to metabolic stone prevention.Methods: Using medical claims from a cohort of working age adults with kidney stone diagnoses (2008-2017), we identified the subset who were prescribed thiazides, alkali therapy, or allopurinol-collectively k...
| Publicado en: | Urology Vol. 149; pp. 81 - 89 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Mar2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=149074276&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 149074276 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00904295 1YG jtl: Urology issn: 00904295 maglogo: N pubinfo: dt: Mar2021 vid: 149 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 149074276 149074276 NLM33352163 149074276 10.1016/j.urology.2020.11.054 NLM33352163 149074276 ppf: 81 ppct: 8 formats: tig: atl: Comparison of Selective Versus Empiric Pharmacologic Preventative Therapy With Kidney Stone Recurrence. aug: au: Hsi, Ryan S. Yan, Phyllis L. Goldfarb, David S. Egbuji, Ada Si, Yajuan Shahinian, Vahakn Hollingsworth, John M. affil: Department of Urology, Vanderbilt University Medical Center, Nashville, TN sug: subj: Sulfur Compounds Therapeutic Use Allopurinol Therapeutic Use Recurrence Prevention and Control Kidney Calculi Drug Therapy Middle Age Human Recurrence Prospective Studies Treatment Outcomes Adult Female Young Adult Adolescence Kidney Calculi Epidemiology Kidney Calculi Metabolism Kidney Calculi Urine Male Comparative Studies Multicenter Studies Evaluation Research Validation Studies Middle Aged: 45-64 years Adult: 19-44 years Adolescent: 13-18 years Female Male ab: Objective: To assess the effectiveness of an empiric approach to metabolic stone prevention.Methods: Using medical claims from a cohort of working age adults with kidney stone diagnoses (2008-2017), we identified the subset who were prescribed thiazides, alkali therapy, or allopurinol-collectively known as preventive pharmacologic therapy (PPT). We distinguished between those who had 24-hour urine testing prior to initiating PPT (selective therapy) from those without it (empiric therapy). We conducted a survival analysis for time to first recurrence for stone-related events, including ED visits, hospitalizations, and surgery, up to 2 years after initiating PPT.Results: Of 10,125 patients identified, 2744 (27%) and 7381 (73%) received selective and empiric therapy, respectively. The overall frequency of any stone-related event was 11%, and this did not differ between the 2 groups on bivariate analysis (P = .29). After adjusting for sociodemographic factors, comorbidities, medication class, and adherence, there was no difference in the hazard of a stone-related event between the selective and empiric therapy groups (hazard ratio, 0.97; 95% confidence interval, 0.84-1.12). When considered individually, the frequency of ED visits, hospitalizations, and surgeries did not differ between groups. Greater adherence to PPT and older age were associated with a lower hazard of a stone-related event (both P < .05).Conclusion: Compared to empiric therapy, PPT guided by 24-hour urine testing, on average, is not associated with a lower hazard of a stone-related event. These results suggest a need to identify kidney stone patients who benefit from 24-hour urine testing. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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