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

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 that 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). Sixty-two percent of patients received explanations about their metabolic evaluation results and 77.5%

The metabolic stone evaluation: An opportunity for shared decision-making

“…And we can certainly not ignore our patients, especially as we continue to embrace shared decision-making approaches to medical treatments. As Harmouch et al and others previously have shown, 1,13 the bottom line is that the majority of patients are interested in having more information on their kidney Darren Beiko, MD, MBA, FRCSC Department of Urology, Queen's University, Kingston, ON, Canada…”

“…I n this issue of CUAJ, Harmouch et al assessed adherence to metabolic kidney stone evaluation guidelines, adequacy of physician communication of metabolic evaluation results, and patient interest in stone prevention strategies. 1 The authors surveyed 530 shockwave lithotripsy treatment (SWL) patients across five Canadian institutions and found that adherence to the 2016 CUA guideline 2 was suboptimal. They identified 421 patients (79.4%) with at least one indication for a metabolic kidney stone work evaluation, yet only 176 of these patients (41.8%) actually received a metabolic evaluation.…”