Lower recurrence risk of urinary stone disease with preventive therapy

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Created On: 29/01/2025

This study determined the relationship between preventive therapeutic intervention (like alkali therapy, thiazide diuretics, and uric acid-lowering medications) and the recurrence of clinically significant kidney stone disease.

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Key take away

Prophylactic pharmacological treatment reduces the risk of recurrent urinary stone disease by 19% during the 12-36 month period, with alkali therapy for hypocitraturia showing a 26% reduced recurrence risk.

Background

Method

Data from the Veterans Health Administration were used to identify adults diagnosed with an initial episode of renal stone disease. Based on a 24-hour urine collection, volunteers had at least one urinary abnormality (hypocitraturia, hypercalciuria, or hyperuricosuria). A composite measure of recurrent stone events, including emergency department visits, hospitalizations, or surgeries was the key endpoint ascertained. Cox proportional hazards regression was applied for estimating the link between prophylactic pharmacotherapy and recurrent formation of stones in the urinary tract, adjusting for pertinent patient characteristics.

Result

Among 5,637 participants suffering from urinary anomalies, prophylactic medication use was related to a 19% drop in the likelihood of recurrent urinary stone ailment during the 12-36 months following the initial urine collection (hazard ratio: 0.81). However, the efficiency of therapy diminished with longer follow-up periods (12-48 and 12-60 months), and statistical significance was not reached. When analyzing specific urinary irregularities, only alkali therapy for hypocitraturia showed a remarkable 26% drop in the risk of relapse within the 12-36 month period (hazard ratio: 0.74).

Conclusion

Preventive pharmacological therapy was linked with a reduced likelihood of clinically significant recurrent urinary stone disease within 12-36 months of initial urine collection. However, when investigating individual urinary anomalies, only alkali therapy for hypocitraturia showed a pronounced reduction in recurrence probability.