Preventive pharmacological therapy may help treat urolithiasis, hypercalciuria symptoms
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Key takeaways:
- The study evaluated 13,942 Medicare enrollees with urolithiasis and urine abnormalities.
- Overall, 31% of patients were prescribed preventive pharmacological therapy.
Preventive pharmacological therapy may help to reduce reoccurring symptoms in patients with urolithiasis and hypercalciuria, according to data from a retrospective cohort study.
“Use of thiazide diuretics, alkali and uric acid lowering drugs, collectively known as preventive pharmacological therapy (PPT), can correct these abnormalities,” John M. Hollingsworth, MD, MS, of the NorthShore University HealthSystem in Evanston, Illinois, wrote with colleagues. “Based on pooled data from multiple randomized controlled trials, practice guidelines recommend that PPT be considered in patients with hypercalciuria, hypocitraturia, low urine pH and hyperuricosuria to reduce recurrence risk.”
Researchers evaluated 13,942 Medicare enrollees with urolithiasis who had urine abnormalities, such as hypercalciuria, hypocitraturia, low urine pH or hyperuricosuria after 24-hour urine collections. With exposure to thiazide diuretics for hypercalciuria, alkali for hypocitraturia or low urine pH, or uric acid lowering drugs for hyperuricosuria, patients were grouped into one of the following three cohorts: adherent to guideline-concordant PPT, nonguideline-concordant adherent or untreated. The goal was to assess the impact of PPT on symptomatic stone events.
Overall, 31% of patients were prescribed PPT, according to the study. Researchers found an association between adherence to PPT and a lower incidence of symptomatic stone events for patients with hypercalciuria and low urine pH, which they wrote was driven largely by lower rates of ED after the initiation of PPT in the concordant/adherent group compared with untreated patients.
Additionally, patients with hypercalciuria had a 3.8% 2-year predicted probability of a visit for the concordant/adherent PPT group compared with 6.9% of patients for the no-treatment group. Patients with low urine pH had a 4.3% chance for adherent PPT compared with 7.3% for the no-treatment group.
The study had potential bias from the likelihood that patients prescribed PPT may have had more severe urolithiasis than untreated patients, according to Hollingsworth and colleagues.
“Notwithstanding these limitations, our study has important implications for the management of urolithiasis,” they wrote. “As the lack of data on clinically relevant outcomes has dampened enthusiasm for PPT, these findings may inform patients and clinicians regarding the potential benefits of these treatments. Future empirical work, perhaps in the context of a large multicenter pragmatic trial, could answer these open questions as well as clarify the tolerability and cost efficiency of PPT.”
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