24-hour urine testing guides preventive pharmacological therapy for recurrent stones

Preventive pharmacological therapy, when guided by findings from 24-hour urine testing, appears beneficial to patients with a history of recurrent urinary stone disease, a study reports.

The study used medical claims data from working-age adults with urinary stone disease and included those with a prescription fill for a preventive pharmacological therapy agent (eg, thiazide diuretic, alkali therapy, or allopurinol).

Researchers stratified patients into subgroups based on the presence of a concomitant condition or other factors that raised their stone recurrence risk. They used multivariable regression models to evaluate the association between stone-related events (eg, emergency department visit, hospitalization, and surgery) and 24-hour urine testing before prescription of preventive pharmacological therapy.

A total of 8,369 adult patients with urinary stone disease had a concomitant condition that raised their recurrence risk. Of these, 2,722 patients (33 percent) were prescribed preventive pharmacological therapy after 24-hour urine testing (selective treatment; median follow-up, 590 days), while the rest (n=5,647, 67 percent) received treatment empirically (median follow-up, 533 days).

Compared with patients treated empirically, those who had a history of recurrent stone disease had a significantly lower risk of a subsequent stone-related event if they received selective preventive pharmacological therapy (hazard ratio, 0.83, 95 percent confidence interval, 0.71–0.96).

There were no significant associations for selective preventive pharmacological therapy noted in the other high-risk subgroups.