For a study, researchers sought to assess the frequency of stone-related events in high-risk patients with and without 24-hour urine testing prior to the prescription of preventive pharmaceutical treatment (PPT). While recent studies demonstrated that a selective strategy to PPT for urinary stone disease (USD) has little benefit on average, there may be variation in treatment impact across patient subgroups.

They identified persons having a prescription fill for a PPT agent (thiazide diuretic, alkali therapy, or allopurinol) using medical claims data from working-age adults and their dependents with USD (2008-2019). ). The patients were subsequently divided into subgroups depending on the existence of the concurrent disease or other characteristics that increased their chance of stone recurrence. Finally, they used multivariable regression models to examine the relationship between store-related events (emergency department visits, hospitalization, and surgery) and 24-hour urine tests before PPT prescription in the high-risk category.

In all, 8,369 persons with USD had a concurrent condition that increased their chance of recurrence. About 33% (n=2,722) of these patients were administered PPT following 24-hour urine testing (median follow-up, 590 days), and 67% (n=5,647) were prescribed PPT on the basis of empirical evidence (median follow-up, 533 days). Individuals with a history of recurrent USD who underwent selective PPT had a considerably decreased risk of a second stone-related incident compared to patients treated empirically (hazard ratio, 0.83; 95% CI, 0.71-0.96). In the other high-risk groupings, no significant connections were seen for selected PPT.

Patients with a history of recurrent USD benefit from PPT when directed by 24-hour urine testing results.

Reference: goldjournal.net/article/S0090-4295(22)00140-6/fulltext