Golomb D. et al., 2025: The impact of a multidisciplinary clinic on patient adherence to kidney stone prevention therapy.

Golomb D, Confino I, Avda Y, Lieba A, Hausmann M, Cooper A, Raz O.
World J Urol. 2025 Dec 4;44(1):11. doi: 10.1007/s00345-025-06125-y

Abstract

Objective: To evaluate patient adherence to prescribed medical therapy for urolithiasis following multidisciplinary consultation in a specialized stone clinic.

Patients and methods: A prospective survey-based study was conducted among high-risk stone formers treated at a multidisciplinary metabolic stone clinic staffed by an endourologist, nephrologists, and dietitians. Patients prescribed medical therapy were contacted by phone. After oral consent, a structured questionnaire assessing adherence and reasons for non-compliance was administered. Patients who declined or were unreachable after three attempts were excluded.

Results: A total of 100 patients were included (median age 55 years; 65% male). A family history of nephrolithiasis was reported by 57.4%. Prior interventions included ureteroscopy (URS) (74%), shock wave lithotripsy (SWL) (18%), and percutaneous nephrolithotripsy (PCNL) (15%). The most common stone type was calcium oxalate monohydrate (45.5%). Metabolic abnormalities included hypercalciuria (38.6%), hypocitraturia (34.7%), and hyperuricosuria (23.8%). Full compliance was reported by 57%, partial by 21%, and non-compliance by 22%, with a median adherence duration of 16 months among fully adherent patients. Common reasons for non-compliance included lack of understanding (28%), adverse effects (19%), and perceived lack of necessity (19%). Multivariable analysis identified higher level of education as the only significant predictor of improved adherence (OR 0.38, 95% CI: 0.18-0.78, p = 0.008). Use of specific medications was not significantly associated with the reported adherence or lack there of.

Conclusions: Adherence rates were higher than previously reported, highlighting the benefit of a multidisciplinary approach with individualized metabolic evaluation and targeted therapy in stone-forming patients.

Comment Hans-Göran Tiselius

The high risk of recurrent stone formation as well as regrowth of residual stones and fragments have made metabolic risk evaluation and treatment an essential part of stone treatment. Generally, the compliance with such steps is low but different approaches have been tried.

The authors of this Israeli report used a metabolic stone clinic comprising an endourologist, a nephrologist and a dietitian to optimize treatment.

Stone analysis, serum analysis and composition of two 24h urine samples provided the basis for the treatment. The procedure started with a clinic session whereas follow-up was conducted by telephone calls.

The most common findings were:

COM              46%

COD              15%

CarpAp          14%

Uric acid/urate 14%

CaP                11%

Brushite           2%

Struvite            3%

Hypercalciuria        39%

Hypocitraturia        35%

Hyperuricosuria      24%

Hyperoxaluria        18%

High U-Na             19%

Cystinuria              2%

It is of note that whereas 75% of the patients complied with the treatment after 1 year, only 40% did so after 4 years. The compliance was highest in patients with long education (>12 y).

The conclusion was that this multidisciplinary model was reasonably good but also that long-term recurrence prevention is difficult. Effects on stone formation were not part of the report.

The important message is that in order to get patients to adherence to recurrence preventive programs it is necessary to have a well-organized metabolic clinic with regular and careful follow-up.

Hans-Göran Tiselius