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| Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones |
Braulio Omar Manzoa,*( ),Jose David Cabreraa,Esteban Emilianib,Hector Manuel Sáncheza,Brian Howard Eisnerc,Jose Ernesto Torresa
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a Urology Department, Hospital Regional de Alta Especialidad del Bajío, Blvd. Milenio #130, Col. San Carlos la Roncha, León, Guanajuato, Mexico
b Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
c Urology Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA |
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Abstract Objective: To assess the effect of the adherence to medical treatment on urinary parameters in the 24-h metabolic study of patients with kidney stones.
Methods: A retrospective, longitudinal, descriptive, and observational study was carried out by reviewing the hospital electronic medical record from 2014 to 2018. The adherence to drug treatment was measured 6 months after its initiation, and the numerical values of the metabolic studies were compared. Wilcoxon tests were performed to compare the difference before and after treatment.
Results: Ninety patients were evaluated, with 73.3% of adherence. The 180-day overall adherence rate was 61.2% in patients treated with a single drug and 85.4% in patients treated with multiple drugs. There is a statistically significant increase in citrate levels in patients with good adherence in comparison with non-adherent patients (p=0.031 vs. p=0.528).
Conclusions: Medical treatment and dietary measures in patients with kidney stones have an initial impact at 6 months on the values of the main urinary metabolic alterations that predispose to calculi formation; the most significant is seen in those patients with adherence to medical treatment for hypocitraturia.
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Received: 09 November 2019
Available online: 06 August 2020
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Corresponding Authors:
Braulio Omar Manzo
E-mail: bmanzo@urocem.com
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| Characteristics | Patients | Percentage (%) | | Gender, n | | Male | 50 | 55.6 | | Female | 40 | 44.4 | | Age (year) | 45.4 (13.2)a | | | DM2, n | 8 | 8.9 | | HTN, n | 25 | 27.8 | | BMI (kg/m2) | 28.8 (4.3)a | | | Normal, n | 17 | 18.9 | | Overweight, n | 42 | 46.7 | | Grade I Obesity, n | 30 | 33.3 | | Grade II Obesity, n | 1 | 1.1 | | Stone volume (mm2) | 252 (124-447.3)b | | | Number of Stones, n | 2 (1-3)b | | | Urinary Metabolic Disorders, n | 189 | | | Hypocitraturia | 78 | 41.26 | | Hyperoxaluria | 53 | 28.04 | | Hypercalciuria | 31 | 16.40 | | Hyperuricosuria | 27 | 14.28 |
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Baseline and demographic characteristics.
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| Metabolic disorder | Before, mean (range) | After, mean (range) | p-Value | | Hypocitraturia (n=78) | | Urinary pH | 6 (5-7) | 6 (5.5-6.75) | 0.473 | | 24 h urine Cit (mg/d) | 62 (20.5-208) | 189 (40-274) | 0.015* | | 24 h volume (mL) | 1900 (1485-2585) | 2210 (1600-2740) | 0.561 | | Hyperuricosuria (n=27) | | Urinary pH | 6 (5.5-6.7) | 6 (5.5-6.8) | 0.606 | | 24 h urine UA (g/d) | 0.8 (0.5-10) | 0.7 (0.5-0.9) | 0.021* | | 24 h volume (mL) | 2100 (1780-2800) | 2145 (1500-2970) | 0.764 | | Hypercalciuria (n=31) | | Urinary pH | 6 (5.3-6.5) | 6 (5.8-6.5) | 0.425 | | 24 h urine Ca (mg/d) | 302.4 (172.2-367.4) | 261.8 (208-342) | 0.854 | | 24 h volume (mL) | 2200 (1720-2970) | 2360 (1700-2920) | 0.984 | | Hyperoxaluria (n=53) | | 24 h urine Ox (mmol/d) | 0.6 (0.5-0.8) | 0.6 (0.5-0.8) | 0.906 | | 24 h volume (mL) | 2390 (1845-2950) | 2440 (1800-2965) | 0.468 |
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Differences between the first metabolic study and its control 6 months after the start of medical treatment.
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| Metabolic alteration | Variable | Before, mean (range) | After, mean (range) | p-Value | | Hypocitraturia (n=78) | 24 h Cit (mg/d) | 60 (18-191.5) | 141.5 (29.2-274) | 0.031* | | Hyperuricosuria (n=27) | 24 h UA (g/d) | 0.8 (0.4-22.6) | 0.6 (0.4-0.9) | 0.088 | | Hypercalciuria (n=31) | 24 h Ca (mg/d) | 297.5 (167.7-366.9) | 261.8 (191.7-342.0) | 0.889 | | Hyperoxaluria (n=53) | 24 h Ox (mmol/d) | 0.6 (0.5-0.8) | 0.6 (0.4-0.7) | 0.286 |
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Changes showed in the 24-hour urine parameters in patients with adherence to medical and dietary treatment.
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| Metabolic alteration | Variable | Before, mean (range) | After, mean (range) | p-Value | | Hypocitraturia (n=78) | 24 h Cit (mg/d) | 130 (32-322) | 248.5 (80.7-281.5) | 0.528 | | Hyperuricosuria (n=27) | 24 h UA (g/d) | 0.8 (0.6-5.9) | 0.7 (0.6-4.9) | 0.327 | | Hypercalciuria (n=31) | 24 h Ca (mg/d) | 305.1 (226.1-305.1) | 228.7 (213.2-228.7) | 0.655 | | Hyperoxaluria (n=53) | 24 h Ox (mmol/d) | 0.4 (0.3-0.7) | 0.6 (0.5-0.8) | 0.374 |
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Changes showed in the 24-hour urine parameters in patients with no adherence to medical and dietary treatment.
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| [1] |
Pearle MS, Antonelli JA, Lotan Y. Urinary lithiasis: etiology, epidemiology, and pathogenesis. In: Campbell-walsh urology. 11th ed. Elsevier Inc; 2019. p.1170-99.
|
| [2] |
Rule AD, Lieske JC, Li X, Melton 3rd LJ, Krambeck AE, Bergstralh EJ. The ROKS nomogram for predicting a second symptomatic stone episode. J AmSoc Nephrol 2014; 25:2878-86.
|
| [3] |
Medina-Escobedo M, Zaidi M, Real-de León E, Orozco-Rivadeneyra S. Urolithiasisprevalenceandrisk factors inYucatan, Mexico. Salud Publica Mex 2002; 44:541-5 [Article in Spanish].
doi: S0036-36342002000600006
pmid: 20383456
|
| [4] |
Coe FL, Kavalach AG. Hypercalciuria and hyperuricosuria in patients with calcium nephrolithiasis. N Engl J Med 1974; 291:1344-50.
doi: 10.1056/NEJM197412192912510
|
| [5] |
Pak CY, Nicar M, Northcutt C. The definition of the mechanism of hypercalciuria is necessary for the treatment of recurrent stone formers. Contrib Nephrol 1982; 33:136-51.
pmid: 6749417
|
| [6] |
Corder CJ, Leslie SW. 24-Hour urine collection [Updated 2020 May 27]. [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482482/.
|
| [7] |
Pak CY. Etiology and treatment of urolithiasis. Am J Kidney Dis 1991; 18:624-37.
pmid: 1962646
|
| [8] |
Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002; 346:77-84.
doi: 10.1056/NEJMoa010369
|
| [9] |
Parks JH, Goldfisher E, Asplin JR, Coe FL. A single 24-hour urine collection is inadequate for the medical evaluation of nephrolithiasis. J Urol 2002; 167:1607-12.
doi: 10.1016/S0022-5347(05)65163-4
|
| [10] |
Ostenberg L, Blaschke T. Adherence to medication. NEJM 2005; 353:487-97.
doi: 10.1056/NEJMra050100
|
| [11] |
Choudhry NK, Shrank WH, Levin RL, Lee JL, Jan SA, Brookhart MA, et al. Measuring concurrent adherence to multiple related medications. Am J Manag Care 2009; 15:457-64.
pmid: 19589013
|
| [12] |
Lemstra M, Nwankwo C, Bird Y, Moraros J. Primary nonadherence to chronic disease medications: a meta-analysis. Patient Prefer Adherence 2018; 12:721-31.
doi: 10.2147/PPA
|
| [13] |
De Geest S, Sabaté E. Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs 2003; 2:323. https://doi.org/10.1016/S1474-5151(03)00091-4.
doi: 10.1016/S1474-5151(03)00091-4
|
| [14] |
Parks JH, Asplin JR, Coe FL. Patient adherence to long-term medical treatment of kidney stones. J Urol 2001; 166:2057-60.
doi: 10.1016/S0022-5347(05)65505-X
|
| [15] |
Eisner BH, Goldfarb DS, Pareek G. Pharmacologic treatment of kidney stone disease. Urol Clin North Am 2013; 40:21-30.
doi: 10.1016/j.ucl.2012.09.013
|
| [16] |
Hennessey DB, Kinnear N, Rice G, Curry D, Woolsey S, Duggan B. Compliance in patients with dietary hyperoxaluria: a cohort study and systematic review. Asian J Urol 2019; 6:200-7.
doi: 10.1016/j.ajur.2018.03.002
pmid: 31061807
|
| [17] |
Dauw CA, Yi Y, Bierlein MJ, Yan P, Alruwaily AF, Ghani KR, et al. Factors associated with preventive pharmacological therapy adherence among patients with kidney stones. Urology 2016; 93:45-9.
doi: 10.1016/j.urology.2016.03.030
|
| [18] |
Dauw CA, Yi Y, Bierlein MJ, Yan P, Alruwaily AF, Ghani KR, et al. Medication nonadherence and effectiveness of preventive pharmacological therapy for kidney stones. J Urol 2016; 195:648-52.
doi: 10.1016/j.juro.2015.10.082
|
| [19] |
Zisman AL. Effectiveness of treatment modalities on kidney stone recurrence. Clin J Am Soc Nephrol 2017; 12:1699-708.
doi: 10.2215/CJN.11201016
|
| [20] |
Ettinger B, Tang A, Citron JT, Livermore B, Williams T. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med 1986; 315:1386-9.
doi: 10.1056/NEJM198611273152204
|
| [21] |
Siener R, Schade N, Nicolay C, Von Unruh GE, Hesse A. The efficacy of dietary intervention on urinary risk factors for stone formation in recurrent calcium oxalate stone patients. J Urol 2005; 173:1601-5.
doi: 10.1097/01.ju.0000154626.16349.d3
|
| [22] |
Pak CY, Sakhaee K, Crowther C, Brinkley L. Evidence justifying a high fluid intake in treatment of nephrolithiasis. Ann Intern Med 1980; 93:36-9.
pmid: 7396311
|
| [23] |
Ilyas R, Chow K, Young JG. What is the best method to evaluate urine pH? A trial of three urinary pH measurement methods in a stone clinic. J Endourol 2015; 29:70-4.
doi: 10.1089/end.2014.0317
|
| [24] |
Ettinger B, Pak CY, Citron JT, Thomas C, Adams-Huet B, Vangessel A. Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J Urol 1997; 158:2069-73.
doi: 10.1016/S0022-5347(01)68155-2
|
| [25] |
Ettinger B, Citron JT, Livermore B, Dolman LI. Chlorthalidone reduces calcium oxalate calculous recurrence but magnesium hydroxide does not. J Urol 1988; 139:679-84.
doi: 10.1016/S0022-5347(17)42599-7
|
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