2252 UNDERUTILIZATION OF 24-HOUR URINE TESTING IN KIDNEY STONE PATIENTS

Abstract

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management (II)1 Apr 20132252 UNDERUTILIZATION OF 24-HOUR URINE TESTING IN KIDNEY STONE PATIENTS David C. Johnson, James E. Ferguson, E. Will Kirby, D. Kim Chantala, and Davis P. Viprakasit David C. JohnsonDavid C. Johnson Chapel Hill, NC More articles by this author , James E. FergusonJames E. Ferguson Chapel Hill, NC More articles by this author , E. Will KirbyE. Will Kirby Chapel Hill, NC More articles by this author , D. Kim ChantalaD. Kim Chantala Chapel Hill, NC More articles by this author , and Davis P. ViprakasitDavis P. Viprakasit Chapel Hill, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2161AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clinical guidelines recommend the use of metabolic testing, specifically 24-hour urine studies, in appropriate patients to determine directed therapy for stone prevention. Recent reports, however, suggest that many patients with risk factors do not undergo appropriate testing. We sought to determine the utilization of 24-hour urine studies in kidney stone patients within a large claims dataset of privately insured patients. METHODS We retrospectively queried patients within the Marketscan® Commercial Claims and Encounters Databases between 2000 and 2010. A cohort of patients with at least one year of data prior to kidney stone diagnosis and a minimum of five years of continuous follow-up data was selected for analysis. Urine studies including urinary calcium, citrate, oxalate, uric acid, creatinine, pH and sodium were evaluated individually and as a complete group. Kidney stone surgery was considered only once per six month period. Patients undergoing stone surgery over multiple six month periods were defined as recurrent stone formers. RESULTS Of 68,268 kidney stone patients, 16,404 (24%) patients underwent at least one individual urine study and 3,503 patients (5%) underwent at least one complete urine study within the study period. Ordering of individual urine testing included urine creatinine (86%), calcium (47%), uric acid (44%), oxalate (42%), citrate (40%), sodium (36%) and pH (27%). In 11,133 recurrent stone patients, 4,432 (40%) underwent at least one individual urine study and 1,530 (14%) underwent at least one complete urine study. Patients under the age of 20 and those from the West and Northeast United States had higher rates of urine evaluation. Urine testing was significantly higher with increasing number of stone surgery periods (p<0.0001). However, only 51.5% of patients with five or more stone surgery periods underwent any urine studies. CONCLUSIONS Our findings suggest that based on claims data 24-hour urine testing is underutilized in kidney stone patients. Though results varied some with patient demographics, overall a majority of patients with evidence of recurrent stones within our cohort did not undergo guideline recommended urine studies. Further analysis is required to determine the significance in rates of stone recurrence in these patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e923-e924 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information David C. Johnson Chapel Hill, NC More articles by this author James E. Ferguson Chapel Hill, NC More articles by this author E. Will Kirby Chapel Hill, NC More articles by this author D. Kim Chantala Chapel Hill, NC More articles by this author Davis P. Viprakasit Chapel Hill, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...