目的:支持预防性药物治疗(PPT)减少尿石症复发的疗效的数据是基于临床试验的复合结局,其中包括影像学检查结果,具有不确定的临床意义。这项研究试图评估使用PPT是否会减少症状性结石事件。
方法:回顾性队列研究。
方法:&参与者:完成24小时尿液收集并显示高钙尿症的尿石症患者,低柠檬酸血症,尿液pH低,或者是尿毒症.
方法:PPT(噻嗪类利尿剂治疗高钙尿症,用于低柠檬酸血症或低尿液pH值的碱,或用于高尿酸尿症的降尿酸药物)归类为,1)遵守指南一致的PPT,2)不遵守指南一致的PPT,或3)未经处理。
结果:症状性结石事件发生(急诊[ED]就诊或因尿石症或结石定向手术住院)。
方法:Cox比例风险回归。
结果:在13,942名患者中,31.0%为处方PPT。与没有治疗相比,对于高钙尿症患者,一致/粘附PPT的使用与症状性结石事件的风险显着降低相关(风险比[HR],0.736[95%置信区间(CI),0.593至0.915])和低尿液pH(HR,0.804[CI,0.650至0.996]),但不适用于低尿尿或尿毒症患者。这些关联很大程度上是由一致/粘附组与未经治疗的患者相比,在启动PPT后ED就诊率明显较低所驱动的。高钙尿症患者调整了一致/粘附PPT和不治疗组的两年预期访视概率为3.8%[95%CI,2.5%至5.2%]和6.9%[95%CI,6.0%至7.7%],分别。在尿液pH值低的患者中,这些概率分别为4.3%[95%CI,2.9%至5.7%]和7.3%[95%CI,6.5%至8.0%],分别。
结论:处方PPT的患者可能比未经治疗的患者有更严重的疾病。
结论:患有尿石症和高钙尿症的患者坚持使用噻嗪类利尿剂治疗,以及那些坚持处方碱治疗的尿液pH低的患者,其症状性结石事件少于未治疗的患者。
OBJECTIVE: Data supporting the efficacy of preventive pharmacological therapy (PPT) to reduce urolithiasis recurrence are based on clinical trials with composite outcomes that incorporate imaging findings and have uncertain clinical significance. This
study evaluated whether the use of PPT leads to fewer symptomatic stone events.
METHODS: Retrospective cohort
study.
METHODS: Medicare enrollees with urolithiasis who completed 24-hour urine collections that revealed hypercalciuria, hypocitraturia, low urine pH, or hyperuricosuria.
METHODS: PPT (thiazide diuretics for
hypercalciuria, alkali for hypocitraturia or low urine pH, or uric acid lowering drugs for hyperuricosuria) categorized as (1) adherent to guideline-concordant PPT, (2) nonadherent to guideline-concordant PPT, or (3) untreated.
RESULTS: Symptomatic stone event occurrence (emergency department [ED] visit or hospitalization for urolithiasis or stone-directed surgery).
METHODS: Cox proportional hazards regression.
RESULTS: Among 13,942 patients, 31.0% were prescribed PPT. Compared with no treatment, concordant/adherent PPT use was associated with a significantly lower hazard of symptomatic stone events for patients with hypercalciuria (HR, 0.736 [95% CI, 0.593-0.915]) and low urine pH (HR, 0.804 [95% CI, 0.650-0.996]) but not for patients with hypocitraturia or hyperuricosuria. These associations were largely driven by significantly lower rates of ED visits after initiating PPT among the concordant/adherent group versus untreated patients. Patients with
hypercalciuria had adjusted 2-year predicted probabilities of a visit of 3.8% [95% CI, 2.5%-5.2%%] and 6.9% [95% CI, 6.0%-7.7%] for the concordant/adherent PPT and no-treatment groups, respectively. Among patients with low urine pH, these probabilities were 4.3% (95% CI, 2.9%-5.7%) and 7.3% (95% CI, 6.5%-8.0%) for the concordant/adherent PPT and no-treatment groups, respectively.
CONCLUSIONS: Potential bias from the possibility that patients prescribed PPT had more severe disease than untreated patients.
CONCLUSIONS: Patients with urolithiasis and
hypercalciuria who were adherent to treatment with thiazide diuretics as well as those with low urine pH adherent to prescribed alkali therapy had fewer symptomatic stone events than untreated patients.
UNASSIGNED: Despite multiple clinical trials demonstrating the efficacy of thiazide diuretics and alkali for secondary prevention of kidney stones, they are infrequently prescribed due in part to a lack of data about their effectiveness in real-world settings. We analyzed medical claims from older adults with kidney stones for whom urine chemistry data were available. We found that patients who took prescribed thiazide diuretics for elevated urine calcium levels or alkali for low urinary pH were less likely to experience symptomatic stone recurrences than untreated patients. This benefit was expressed as lower rates of emergency department visits after initiating therapy. Our findings should inform the prescription of and adherence to treatment with thiazide diuretics and alkali for the prevention of recurrent kidney stones.