Compliance in patients with dietary hyperoxaluria: A cohort study and systematic review

doi:10.1016/j.ajur.2018.03.002

Asian Journal of Urology, 2018, 6 (2): 200-207 doi: 10.1016/j.ajur.2018.03.002

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Compliance in patients with dietary hyperoxaluria: A cohort study and systematic review

Derek B. Hennessey^a,b,*(

),Ned Kinnear^b,Gilbert Rice^a,David Curry^a,Siobhan Woolsey^a,Brian Duggan^a,c

a.Department of Urology, Belfast City Hospital, Belfast, United Kingdom;
b.Department of Urology, Austin Hospital, Melbourne, Australia;
c.Department of Urology, Ulster Hospital, Belfast, United Kingdom

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Abstract

Objective Hyperoxaluria leads to calcium oxalate crystal formation and subsequent urolithiasis. This study aims to analyse the effect of treatment compliance in hyperoxaluria, firstly by analysis of patients with non-primary hyperoxaluria and secondly via systematic review in patients with any hyperoxaluria.Methods In a retrospective cohort study, adults with non-primary hyperoxaluria managed with dietary counselling in 2013 were enrolled. Twenty-four-hour (24 h) urine collections initially and at 6 months were obtained. Compliance was assessed by self-reported dietary compliance and 24 h urinary volume >2 L. Patients were followed for 24 months. Primary outcomes were urinary oxalate and calcium 24 h load at 6 months, and urolithiasis-related procedural rates at 24 months. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compatible systematic review of compliance among hyperoxaluric patients was performed.Results In the cohort study, of 19 eligible patients (4 female) with median age 52 years, 10 (53%) were considered compliant. Compared with the non-compliant group, these patients had significantly increased subsequent 24 h urinary volume (2250 mL vs. 1600 mL; p = 0.008) and lower procedural rates (10% vs. 56%; p = 0.033). Subsequent 24 h urinary oxalate load was non-significantly lower in compliant patients. Systematic review regarding compliance in hyperoxaluric patients revealed five studies. Only one utilised dietary counselling or analysed compliant vs. non-compliant patients, finding no difference. None examined the effect of compliance on procedural rates.Conclusion Hyperoxaluria is an important cause of recurrent urolithiasis. Increasing fluid intake and reducing dietary oxalate reduce the risk of operative intervention and remain fundamental to the treatment of hyperoxaluria.

Key words： Hyperoxaluria Urolithiasis Recurrent stone former Metabolic stone disease

Received: 02 April 2017 Available online: 29 March 2018

Corresponding Authors: Derek B. Hennessey E-mail: derek.hennessey@gmail.com

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Cite this article:

Derek B. Hennessey,Ned Kinnear,Gilbert Rice, et al. Compliance in patients with dietary hyperoxaluria: A cohort study and systematic review[J]. Asian Journal of Urology, 2018, 6(2): 200-207.

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http://www.ajurology.com/EN/10.1016/j.ajur.2018.03.002 OR http://www.ajurology.com/EN/Y2018/V6/I2/200

Patient characteristics.

First 24 h collection indications and findings.

Comparison of initial and subsequent 24 h urine collection results between compliant and non-compliant groups, median (IQR).

Impact of compliance on 24 h urinary oxalate excretion. (A) Non complaint (n = 9); (B) Complaint patients (n = 10).

Effect at 6 months of thiazide diuretics on 24 h urinary oxalate and calcium excretion. (A) Urinary oxalate 24 h excretion; (B) Urinary calcium 24 h excretion.

PRISMA flow diagram of citations reviewed in the course of systematic review of compliance to intervention in patients with hyperoxaluria. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Year	Author	Nation	Population	Methods	N	Outcomes
2013	Schwen et al. [19]	USA	Adults with idiopathic hyperoxaluria, renal stones, at least two 24 h urine collections >30 days apart and non-operative management	Retrospective cohort study with contemporary controls. Oxalate-avoidant dietary counselling was given. Compliance was measured by self-reporting, improvement in urine volume and ability to keep follow-up appointments.	149	132/149 (89%) compliant. Overall, mean UrOx was significantly reduced (p < 0.001), however no difference between compliant and non-compliant UrOx (p = 0.84).
2011	Hoppe et al. [20]	Germany	Children and adults with primary hyperoxaluria	Double-blind randomised placebo-controlled trial. Oral Oxalobacter formigenes (10⁷ colony forming units) twice daily for 24 weeks. Compliance self-reported.	42	37/42 (88%) compliant. Overall vs. placebo, no significant change in mean UrOx (p = 0.62). Compliant vs. non-compliant UrOx not compared.
1995	Leumann et al. [21]	Switzerland	Children with primary hyperoxaluria	Prospective interventional study with no controls. Oral sodium citrate (0.10-0.15 g/kg) daily, long term (mean 4 years). Compliance measured by variability in urinary pH and citrate load.	7	3/5 (60%) compliant (other two lost to follow-up). Overall, significant decrease in mean UrOx (p = 0.02). Compliant vs. non-compliant UrOx not compared.
1991	Edwards et al. [22]	UK	Adults with no disease, primary hyperoxaluria or mild metabolic hyperoxaluria	Prospective interventional study with healthy controls. Oral pyridoxine of various dosage. Compliance measured by urinary 4-pyridoxic acid.	15	15/15 (100%) compliant. Compared to those with healthy patients, patients with mild metabolic hyperoxaluria, patients (p < 0.01) but not with primary hyperoxaluria displayed lower serum pyridoxal phosphate levels. No measurement of UrOx. No non-compliant patients for comparison.
1989	D'Cruz et al. [23]	UK	Adults with enteric hyperoxaluria due to Crohn's disease+/-bowel resection	Prospective interventional study with no controls. Comparison of 24 h urine collection before and after 2 weeks of oral allopurinol 300 mg daily. Compliance measured by fall in plasma uric acid.	8	8/8 (100%) patient compliant. Overall, no change in mean UrOx (p = n/s). No non-compliant patients for comparison.

Eligible studies resulting from systematic review of intervention compliance among patients with hyperoxaluria.

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