PD21-03 TWENTY-FOUR HOUR URINE TESTING AND URINARY STONE DISEASE RECURRENCE IN VETERANS

Abstract

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (PD21)1 Sep 2021PD21-03 TWENTY-FOUR HOUR URINE TESTING AND URINARY STONE DISEASE RECURRENCE IN VETERANS Shen Song, I-Chun Thomas, Calyani Ganesan, Kyla Velaer, Glenn Chertow, Alan Pao, and John Leppert Shen SongShen Song More articles by this author , I-Chun ThomasI-Chun Thomas More articles by this author , Calyani GanesanCalyani Ganesan More articles by this author , Kyla VelaerKyla Velaer More articles by this author , Glenn ChertowGlenn Chertow More articles by this author , Alan PaoAlan Pao More articles by this author , and John LeppertJohn Leppert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002010.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical practice guidelines differ vis-à-vis the importance of 24-hour urine testing in persons with high-risk or recurrent urinary stone disease (USD). Data supporting the clinical utility of approaches that incorporate 24-hour urine testing in patients with USD are limited. We sought to determine whether 24-hour urine testing in Veterans with USD reduces or delays urinary stone recurrence. METHODS: This is a cohort study of national health record data from the Veterans Health Administration, a large national integrated health care system, from 2007 through 2013. We assembled a cohort of 130,129 Veterans with USD based on diagnostic or procedural codes and excluded those with USD claims in the two years before cohort entry. We created a propensity-score matched cohort of 14,854 Veterans and compared outcomes in patients who did and did not undergo 24-hour urine testing within 6 months of stone diagnosis. The primary outcome was time-to-next clinically significant stone event, defined as an emergency department visit, inpatient admission related to a urinary stone, or urologic stone procedure with 5-year follow-up. We also did a companion analysis looking at time-to-third stone event in Veterans with already two kidney stone events and who were therefore at known high risk of recurrence. RESULTS: Of 130,129 Veterans with USD, 9,286 (7.1%) completed 24-hour urine testing. Of 14,854 Veterans in the propensity-score matched cohort, 8,560 (57.6%) experienced a recurrent USD event. Completion of 24-hour urine testing was associated with a higher risk of developing a second stone event (hazard ratio (HR) 1.17, 95% confidence interval (95% CI) 1.12-1.22). Among Veterans at high risk of recurrence, we examined time to a third stone event. In this cohort of 4,736 patients, completion of 24-hour urine testing was not associated with a higher risk of developing a third stone event (HR 1.06, 95% CI 0.99-1.12). CONCLUSIONS: Completion of 24-hour urine testing was not associated with a reduction in urinary stone recurrence. These findings challenge the validity of a longstanding recommendation in general medicine, nephrology, and urology practice. Source of Funding: NIH/NIDDK © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e374-e375 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shen Song More articles by this author I-Chun Thomas More articles by this author Calyani Ganesan More articles by this author Kyla Velaer More articles by this author Glenn Chertow More articles by this author Alan Pao More articles by this author John Leppert More articles by this author Expand All Advertisement Loading ...