PD14-09 THE BENEFIT OF OBTAINING 24-HOUR URINE TESTING BEFORE PRESCRIBING PREVENTIVE PHARMACOLOGICAL THERAPY TO PATIENTS WITH HIGH-RISK URINARY STONE DISEASE

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I (PD14)1 Sep 2021PD14-09 THE BENEFIT OF OBTAINING 24-HOUR URINE TESTING BEFORE PRESCRIBING PREVENTIVE PHARMACOLOGICAL THERAPY TO PATIENTS WITH HIGH-RISK URINARY STONE DISEASE Ryan Hsi, Phyllis Yan, Joseph Crivelli, Vahakn Shahinian, and John Hollingsworth Ryan HsiRyan Hsi More articles by this author , Phyllis YanPhyllis Yan More articles by this author , Joseph CrivelliJoseph Crivelli More articles by this author , Vahakn ShahinianVahakn Shahinian More articles by this author , and John HollingsworthJohn Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001990.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent studies show no benefit to a selective approach to preventive pharmacological therapy (PPT) for patients with urinary stone disease (i.e., obtaining 24-hour urine testing before prescribing). Because selective PPT may produce nonrandom differences in outcomes based on individual recurrence risk, we compared the frequency of stone-related events among patients with and without 24-hour urine testing before PPT use in high-risk subgroups. METHODS: Using medical claims data (2008 to 2019), we identified adults with urinary stone disease who had a prescription fill for a thiazide diuretic, alkali therapy, or allopurinol. We stratified them into subgroups based on the presence of a concomitant condition or other factors that raise stone recurrence risk, including (children, urinary tract infection, gout, bone disease, intestinal malabsorption, hyperparathyroidism, staghorn calculus, renal anomalies, sarcoidosis, cystinuria, and prior stone recurrence). We fit multivariable regression models to compare the frequency of a stone-related event (emergency department visit, hospitalization, and surgery) among patients with and without 24-hour urine testing before PPT prescription in these subgroups. RESULTS: Among 5,275 patients with urinary stone disease who had a concomitant high-risk condition, 37% (n=1,954) were prescribed PPT after 24-hour urine testing (median follow-up, 631 days), while 63% (3,321) received PPT empirically (median follow-up, 623 days). Patients with prior stone recurrence 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 to 0.96). The adjusted predicted probability of a stone-related event among patients in this group was five percentage points lower at two years of follow-up for those on selective versus empiric PPT. No significant associations were noted for selective PPT in the other high-risk subgroups. CONCLUSIONS: Patients with a history of recurrent urinary stone disease benefit from PPT when guided by findings from 24-hour urine testing. These data highlight the importance of examining for heterogeneity in treatment effect when comparing stone prevention approaches. Source of Funding: NIH 1R01DK121709-01A1 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e219-e219 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Hsi More articles by this author Phyllis Yan More articles by this author Joseph Crivelli More articles by this author Vahakn Shahinian More articles by this author John Hollingsworth More articles by this author Expand All Advertisement Loading ...