Karger Publishers
Browse
1/1
5 files

Supplementary Material for: Clinical Effectiveness of Calcium Oxalate Stone Treatments

dataset
posted on 2022-11-22, 10:42 authored by Gutbrod J., KeysMcKay C.C., Coe L., Bergsland K., Coe F., Worcester E., Prochaska M.
Introduction: Lowering kidney stone risk and urine calcium oxalate supersaturation is a primary clinical focus for kidney stone prevention and can be achieved with multiple strategies. Common strategies include advice to increase fluid intake, restrict dietary sodium, or prescribing a thiazide-type diuretic. We investigated how physicians make these decisions in real-world practice and evaluate their efficacy based on 24-hour urine collections. Methods: We reviewed medical charts for 203 kidney stone formers with idiopathic calcium stones from University of Chicago Kidney Stone Clinic between 2005-2020. Patients had three 24-hour urines before an initial pre-treatment clinic visit and one follow up 24-hour urine. We analyzed changes in urine composition based on treatment advice using t-tests and ANOVA. Results: Patients who received advice to increase fluid intake had lower urine volume at baseline (1.5 vs. 2.5 L/day, p<0.001) and larger increase in urine volume at follow up (0.6 vs. 0.1 L/day, p<0.001) compared to those who did not receive the advice. Patients who were advised to restrict dietary sodium had a higher urine sodium at baseline (208 vs. 139 mEq/day, p<0.001), a larger reduction in urine sodium (-28 vs 13 mEq/day, p=0.002) and larger reduction in urine calcium (-74 vs -28 mg/day, p=0.005) compared with those not advised to restrict dietary sodium. Patients started on a thiazide had a higher baseline urine calcium (281 vs 213 mg/day) and larger reduction in urine calcium (-83 vs -9 mg/day, p<0.001) compared with patients not started on a thiazide. In combination, thiazide prescriptions with dietary sodium restriction reduced urine calcium by 99 mg/day and reduced calcium oxalate supersaturation from 8.0 to 5.5 and calcium phosphate supersaturation from 1.4 to 1.0. Discussion/Conclusion: Providers use 24-hour urine data to guide treatment strategy decisions. These strategies achieved the intended effects on urine composition and lowered kidney stone risk.

History

Usage metrics

    American Journal of Nephrology

    Categories

    Keywords

    Licence

    Exports