Mp26-11 Adherence to Potassium Citrate and Changes in 24-Hour Urine Stone Risk Parameters

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP26)1 May 2024MP26-11 ADHERENCE TO POTASSIUM CITRATE AND CHANGES IN 24-HOUR URINE STONE RISK PARAMETERS Joseph J. Crivelli, Mary K. Oerline, Naim M. Maalouf, Ryan S. Hsi, Noah Krampe, Kevin B. Smith, Sara L. Best, Brian T. Denton, John R. Asplin, Vahakn B. Shahinian, and John M. Hollingsworth Joseph J. CrivelliJoseph J. Crivelli , Mary K. OerlineMary K. Oerline , Naim M. MaaloufNaim M. Maalouf , Ryan S. HsiRyan S. Hsi , Noah KrampeNoah Krampe , Kevin B. SmithKevin B. Smith , Sara L. BestSara L. Best , Brian T. DentonBrian T. Denton , John R. AsplinJohn R. Asplin , Vahakn B. ShahinianVahakn B. Shahinian , and John M. HollingsworthJohn M. Hollingsworth View All Author Informationhttps://doi.org/10.1097/01.JU.0001009408.66023.77.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medication adherence can influence the effectiveness of preventive pharmacological therapy for urinary stone disease (USD). Information on medication adherence can be limited in administrative datasets, creating a methodological challenge when comparing outcomes of different treatments. Yet, while pharmacy record-based measures of medication adherence have been developed, it is unknown how these compare to biological indicators of medication adherence. Thus, we assessed associations of claims-based and urinary measures of adherence to potassium citrate therapy with changes in 24-hour urine stone risk parameters. METHODS: We identified adults enrolled in Medicare with USD, a baseline 24-hour urine collection (Litholink, 2010-2019), hypocitraturia or low urine pH, a prescription for monotherapy with potassium citrate tablets within 3 months, and a follow-up urine collection 6-12 months after baseline. We excluded patients on other medications for stone prevention or other forms of potassium supplementation and patients with inadequate urine collections based on creatinine excretion. We defined two measures of adherence: (1) percentage of days covered (PDC) over 0-3 months based on pharmacy claims and (2) change in urinary potassium (ΔK) between baseline and follow-up. We assessed the association between PDC and ΔK using an independent t-test and the association of adherence with changes in urinary citrate and pH using ANCOVA. Finally, we compared the strength of association of PDC and ΔK with these changes using a Wald test. RESULTS: Among 854 patients meeting study criteria, 549 (64.3%) were adherent based on pharmacy claims (PDC≥80%) and 492 (57.6%) were adherent based on ΔK≥15 mEq/day. Patients adherent to medication based on pharmacy claims had a significantly higher mean ΔK compared to those not adherent to medication (+25.0 mEq/day vs.+16.7 mEq/day, p<0.001). The adjusted mean increases in urinary citrate and pH among patients adherent to medication significantly exceeded that of patients not adherent to medication (Figure 1). Compared to PDC≥80%, ΔK≥15 mEq/day had a stronger association with change in urinary citrate (p<0.001) and pH (p<0.001). CONCLUSIONS: Compared to pharmacy claims, the increase in urinary potassium was generally more predictive of increased urinary citrate and pH, emphasizing the value of urinary potassium as a measure of adherence. A study comparing these measures of adherence as predictors of stone recurrence is needed. Download PPT Source of Funding: NIH 5R01DK121709 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e417 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Joseph J. Crivelli More articles by this author Mary K. Oerline More articles by this author Naim M. Maalouf More articles by this author Ryan S. Hsi More articles by this author Noah Krampe More articles by this author Kevin B. Smith More articles by this author Sara L. Best More articles by this author Brian T. Denton More articles by this author John R. Asplin More articles by this author Vahakn B. Shahinian More articles by this author John M. Hollingsworth More articles by this author Expand All Advertisement PDF downloadLoading ...