Metabolic evaluation guidelines in patients with nephrolithiasis: Are they being followed? Results of a national, multi-institutional, quality-assessment study

  • Sabrina S. Harmouch University of Montreal
  • Hiba Abou-Haidar University of Montreal
  • Hassan ElHawary McGill University
  • Thomas Grgic University of British Columbia
  • Andrea G. Lantz Dalhousie University
  • Jason Y. Lee University of Toronto
  • Ben H. Chew University of British Columbia
  • Sero Andonian McGill University
  • Naeem Bhojani University of Montreal

Abstract

Introduction: The significant cost burden of kidney stones underscores the importance of best clinical practice in kidney stone management. We evaluated adherence to kidney stone metabolic evaluation guidelines in a Canadian population and the interest of patients with regard to prevention.

Methods: A questionnaire based on Canadian Urological Association (CUA) best practice guidelines was designed. Patients presenting for extracorporeal shockwave lithotripsy treatment (ESWL) were administered this questionnaire to evaluate risk factors of stone disease and assess the use of metabolic evaluations. Patients were asked if they received explanations about their results and if they were interested in kidney stone prevention.

Results: We identified 530 patients at five academic institutions; 79.4% had at least one indication to receive a metabolic evaluation (high-risk stone formers), which increased to 96.6% if first-time stone formers whom reported an interest in metabolic evaluation were included. However, only 41.1 % of these patients had a metabolic evaluation. Endourologists ordered metabolic evaluation more often than other referring urologists (63.6% vs. 36.5%; p<0.001). Furthermore, urologists ordered metabolic evaluations more often than other prescribing physicians (68.9% vs. 31.1%; p<0.001). Sixtytwo percent of patients received explanations about their metabolic evaluation results and 77.5% understood them. Regarding prevention, 84.1% and 83.8% were interested in more explanations and in following a diet or taking a medication, respectively.

Conclusions: Adherence to CUA metabolic evaluation guidelines is suboptimal and could be improved by urologists referring patients for ESWL. Communication between physician and patient may not be adequate. The majority of stone formers are interested in kidney stone prevention.

Published
2018-05-25
How to Cite
Harmouch, S. S., Abou-Haidar, H., ElHawary, H., Grgic, T., Lantz, A. G., Lee, J. Y., Chew, B. H., Andonian, S., & Bhojani, N. (2018). Metabolic evaluation guidelines in patients with nephrolithiasis: Are they being followed? Results of a national, multi-institutional, quality-assessment study. Canadian Urological Association Journal, 12(10). https://doi.org/10.5489/cuaj.5155
Section
Original Research