INTRODUCTION: Despite guidelines for prevention of recurrent renal calculi, routine dietary modification and metabolic evaluation are often not performed. OBJECTIVE: To determine feasibility of a multicenter, pharmacist-staffed program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine. METHODS: A total of 536 consecutive adult patients were referred from 3 Northern California Kaiser Permanente facilities. We determined the proportion of patients who enrolled, received dietary counseling, and completed metabolic evaluation at 12 months. The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. Cystine or struvite kidney stones, renal tubular acidosis, and primary hyperoxaluria were exclusion criteria. RESULTS: Of the 536 patients, 500 agreed to enrollment. Among patients enrolled for 3 months, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-hour urine collection was performed in 80% of patients by 12 months. A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-hour urine testing. The 12-month dropout rate was 12.4%. CONCLUSION: A telemedicine-administered, pharmacist-staffed, protocol-driven program can provide dietary advice and obtain compliance with metabolic testing for patients at high risk of recurrent kidney stones. Rates of metabolic testing and dropout compare favorably with previously reported rates. This report represents, to our knowledge, the first telemedicine-administered, pharmacist-staffed, kidney stone prevention program published in the literature.
INTRODUCTION: Despite guidelines for prevention of recurrent renal calculi, routine dietary modification and metabolic evaluation are often not performed. OBJECTIVE: To determine feasibility of a multicenter, pharmacist-staffed program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine. METHODS: A total of 536 consecutive adult patients were referred from 3 Northern California Kaiser Permanente facilities. We determined the proportion of patients who enrolled, received dietary counseling, and completed metabolic evaluation at 12 months. The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. Cystine or struvite kidney stones, renal tubular acidosis, and primary hyperoxaluria were exclusion criteria. RESULTS: Of the 536 patients, 500 agreed to enrollment. Among patients enrolled for 3 months, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-hour urine collection was performed in 80% of patients by 12 months. A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-hour urine testing. The 12-month dropout rate was 12.4%. CONCLUSION: A telemedicine-administered, pharmacist-staffed, protocol-driven program can provide dietary advice and obtain compliance with metabolic testing for patients at high risk of recurrent kidney stones. Rates of metabolic testing and dropout compare favorably with previously reported rates. This report represents, to our knowledge, the first telemedicine-administered, pharmacist-staffed, kidney stone prevention program published in the literature.
Authors: Margaret S Pearle; David S Goldfarb; Dean G Assimos; Gary Curhan; Cynthia J Denu-Ciocca; Brian R Matlaga; Manoj Monga; Kristina L Penniston; Glenn M Preminger; Thomas M T Turk; James R White Journal: J Urol Date: 2014-05-20 Impact factor: 7.450
Authors: E Mehuys; L Van Bortel; L De Bolle; I Van Tongelen; L Annemans; J-P Remon; M Giri Journal: J Clin Pharm Ther Date: 2010-12-08 Impact factor: 2.512
Authors: Kyle Spradling; Simone L Vernez; Cyrus Khoyliar; Jacob B Morgan; Zhamshid Okhunov; Glenn M Preminger; Michel E Lipkin; Jaime Landman; Ramy F Youssef Journal: J Endourol Date: 2016-02-09 Impact factor: 2.942
Authors: Giacomo Novara; Enrico Checcucci; Alessandro Crestani; Alberto Abrate; Francesco Esperto; Nicola Pavan; Cosimo De Nunzio; Antonio Galfano; Gianluca Giannarini; Andrea Gregori; Giovanni Liguori; Riccardo Bartoletti; Francesco Porpiglia; Roberto Mario Scarpa; Alchiede Simonato; Carlo Trombetta; Andrea Tubaro; Vincenzo Ficarra Journal: Eur Urol Date: 2020-06-18 Impact factor: 20.096