PD21-04 THE FREQUENCY OF METABOLIC ABNORMALITIES FOLLOWING INITIATION OF PREVENTIVE PHARMACOLOGIC THERAPY FOR URINARY STONE DISEASE

Abstract

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (PD21)1 Sep 2021PD21-04 THE FREQUENCY OF METABOLIC ABNORMALITIES FOLLOWING INITIATION OF PREVENTIVE PHARMACOLOGIC THERAPY FOR URINARY STONE DISEASE Joseph Crivelli, Phyllis Yan, Ryan Hsi, and John Hollingsworth Joseph CrivelliJoseph Crivelli More articles by this author , Phyllis YanPhyllis Yan More articles by this author , Ryan HsiRyan Hsi More articles by this author , and John HollingsworthJohn Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002010.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While thiazide diuretics, alkali citrate therapy, and allopurinol—collectively referred to as preventive pharmacologic therapy (PPT)—are a mainstay of urinary stone disease (USD) prevention, their adverse effect profiles remain poorly characterized. Physicians must often extrapolate from data on other conditions (e.g., hypertension, gout) for which these medications are also prescribed, even though the dosing can differ. In this context, we assessed the frequency of metabolic abnormalities following initiation of PPT in a cohort of patients with USD. METHODS: Using medical claims data from working-age adults with USD (2008 to 2017), we identified patients who were prescribed a PPT agent and had at least three years of continuous insurance coverage following their first prescription fill. We measured the frequency of class-specific metabolic abnormalities among these patients: hyperkalemia for alkali citrate therapy; hypokalemia, hyponatremia, hyperglycemia, or hypercalcemia for thiazide diuretics; and elevated liver function tests for allopurinol. We then fit a multivariable logistic regression model to evaluate for an association between the occurrence of a metabolic abnormality and the PPT drug class prescribed. RESULTS: Among a cohort of 3914 patients with USD who were prescribed a PPT agent, 54.3%, 34.5%, and 20.7% received a thiazide diuretic, alkali citrate therapy, and allopurinol, respectively. Overall, 708 patients (18.1%) had at least one metabolic abnormality during a three-year period after PPT prescription. Hyperglycemia after initiating a thiazide diuretic was most frequent, while thiazide-induced hyponatremia was least frequent (Table). Compared to patients prescribed alkali citrate therapy, those prescribed a thiazide diuretic (odds ratio [OR], 11.95; 95% confidence interval [CI], 8.40 to 17.00) or allopurinol (OR, 3.35; 95% CI, 2.16 to 5.20) had significantly higher odds of experiencing a metabolic abnormality. CONCLUSIONS: Nearly one in five patients prescribed PPT for USD prevention will experience a medication-induced metabolic abnormality. These data can be used to counsel patients prior to prescribing PPT. Furthermore, they highlight the importance of guideline-recommended follow-up serum testing after the initiation of PPT. Source of Funding: National Institutes of Health 1R01DK121709-01A1 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e375-e375 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Crivelli More articles by this author Phyllis Yan More articles by this author Ryan Hsi More articles by this author John Hollingsworth More articles by this author Expand All Advertisement Loading ...