Abstract
Introduction
American Urological Association (AUA) guidelines suggest metabolic testing via 24-h urine studies in high-risk, interested first-time stone formers, and recurrent stone formers. If metabolic testing is not available or otherwise not feasible, clinicians may need to utilize empiric therapy. Debility and social barriers, particularly in the elderly population, may limit the practicality of metabolic testing, and therefore, empiric therapy is of particular importance. The aim of this study is to identify whether unique urinary metabolic abnormality profiles exist for octogenarians with calcium oxalate kidney stones, as this may guide empiric stone prevention therapy more precisely in this population.
Materials and methods
Patients with calcium oxalate stones from a single academic kidney stone center in New York, NY, were retrospectively identified in our prospectively managed database. Patient data, including demographic, clinical information, and baseline 24-h urine studies, were collected before initiating any treatment. Subjects were stratified by age (≤ 40, 41–59, 60–79, and ≥ 80 years) to compare the metabolic urinary abnormality profiles between octogenarians and other age groups. Subgroup analyses were also performed to compare results by gender and by the presence of underlying kidney dysfunction. Comparative statistical analysis was carried out using Chi-square tests, Mann–Whitney U tests, and t-tests where appropriate.
Results
Hypocitraturia, low urine pH, and low urine volume were most common in older patients, particularly in octogenarians. Hypercalciuria, hypernatriuria, and hyperuricosuria were more apparent in younger groups.
Conclusion
With increasing age, hypocitraturia, low urine pH, and low urine volume were more prevalent on 24-h urine metabolic testing. We hypothesize increased comorbidity, including medical renal disease, polypharmacy, and dehydration are possible factors contributing to this unique profile. We suggest that empiric therapy targeted towards this profile is important in very elderly stone formers in whom 24-h urine testing may not be possible. Increased hydration, increased fruit and vegetable intake, and low-dose alkali therapy are easy measures to accomplish this.
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Data availability
The data that support the findings of this study are available from the corresponding author upon request.
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RK: protocol/project development, data collection or management, data analysis, and manuscript writing. RB: manuscript writing. AY: protocol/project development, data collection or management, data analysis, and manuscript writing. CC: data collection or management. AF: data collection or management. CC: data collection or management. BG: data analysis. AR: data collection or management, data analysis. JK: data collection or management. WA data collection or management. MG: protocol/project development, data collection or management, data analysis, and manuscript writing.
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None of the authors has any direct conflicts of interest regarding this research project. However, as a general financial disclosure, Dr. Mantu Gupta is compensated for educational training for Cook Urological Inc., Boston Scientific Inc., Olympus Inc., Lumenis Inc., and Retrophin Inc. None of the other authors has relevant financial disclosures.
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Khargi, R., Blake, R.M., Yaghoubian, A.J. et al. Drivers of calcium oxalate stone formation in the octogenarian population. World J Urol 41, 3713–3721 (2023). https://doi.org/10.1007/s00345-023-04619-1
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DOI: https://doi.org/10.1007/s00345-023-04619-1