CUA 2018: Metabolic Evaluation Guidelines in Patients With Nephrolithiasis: Are They Being Followed? Results of a National, Multi-Institutional Quality Assessment Study

Halifax, Nova Scotia ( As Naeem Bhojani, MD, opened his presentation, he began by discussing the current state of kidney stone disease and how its morbidity, recurrent nature, and the significant cost is a burden to society. Therefore, he stressed that clinical endourologist focus more heavily on kidney stone prevention rather than treatment. Bhojani reminded the audience in regard to the AUA’s guidelines and how it recommended metabolic evaluation for high-risk stone formers as well as interested stone formers. Though this is highly recommended, these procedures are seldom carried out. Therefore, Bhojani and his team at the University of Montreal set out to determine the efficacy of metabolic evaluation prescription patterns in stone formers and to assess the patient’s understanding of the disease and their willingness to diet to prevent recurrence. 

To carry out this evaluation, a multi-institutional study was administered between 5 Canadian academic centers across the east, central, and west. The study consisted of a survey with 16 yes/no questions and 4 parts: identify high-risk stone formers, understanding of the disease, interest in prevention, and adequate metabolic screening. At the completion of the study, there were 530 participants with a mean age of 54.4 years. Of these patients, 45.8% were referred by in-community practicing urologists; of these, 40.0% were in an academic practice with a proportion of 14.9% endourologists.

After the study’s completion, only one-third of the participants received a metabolic evaluation. Of the physicians that prescribed metabolic evaluations (urologist, nephrologist, family doctor, or other), the relative percentage of referral was 68.9%, 15.4%, 10.4%, and 4.4%, respectively. From the data shown, there was a significant difference between the prescription of a metabolic evaluation between fellowship trained endourologists and all other urologists. Of the patients, 62% received explanations of their disease’s results and 64% understood their results. The images below highlight similar endpoints about the patients receiving evaluations. 

UroToday CUA 2018 Metabolic Evaluation Guidelines in Patients With Nephrolithiasis

As Bhojani concluded his speech, he scolded the current clinical urology practice by pointing out that the adherence to the AUA metabolic evaluation guidelines is suboptimal. With a reverential tone in his voice, he insisted that patients with nephrolithiasis are interested in prevention and would be highly interested in knowing more about their stone disease and/or would be interested in changing their diet or enrolling in treatment modalities to prevent recurrence. 

Presented by: Sabrina Harmouch1, Hiba Abou-Haidar1, Hassan Elhawary2, Thomas Grgic3, Andrea Lantz4, Ben Chew3, Jason Lee5, Sero Andonian2, Naeem Bhojani1.
Author Information: 
1. Urology, University of Montreal, Montreal, QC, Canada
2. Urology, McGill University, Montreal, QC, Canada
3. Urology, University of British Columbia, Vancouver, BC, Canada
4. Urology, Dalhousie University, Halifax, NS, Canada
5. Urology, University of Toronto, Toronto, ON, Canada

Written By: Zachary Valley Twitter: @ZacharyAValley, (Department of Urology, University of California-Irvine) medical writer for at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia