Physician and Patient Adherence to Kidney Stone Prevention Guidelines in a Diverse, Low-resource, Urban Population

Objective: To assess barriers to guideline-concordant metabolic kidney stone evaluations in a diverse, low-resource, urban population. American Urological Association (AUA) Guidelines recommend that recurrent, high-risk, and interested first-time kidney stone formers undergo metabolic evaluation. Patients with low socioeconomic status are less likely to complete 24-hour urine studies. Methods: We retrospectively identified recurrent or high-risk kidney stone patients who required stone surgery between 2016 and 2022 and completed a validated social needs screening tool. Clinical notes, orders, pharmacy, and laboratory records were reviewed the year before and after surgery. Guideline compliance was assessed with respect to each of the following: recommendation for and completion of 24-hour urine, results counseling, dietary/pharmacologic compliance, and repeat 24-hour urine recommendation and completion. Results: Two hundred eighty patients met inclusion criteria, of whom 25.4% were Black and 51.8% were Hispanic/Latino. Median age was 57 years (IQR 48-65). Of those eligible, 123 (43.9%) were recommended to undergo metabolic evaluation, 70 (25%) completed the collection, 45 (16.1%) had dietary/pharmacologic counseling, 25 (8.9%) were recommended to repeat 24-hour urine, 13 (4.6%) completed this repeat collection, and 10 (3.6%) had a visit to discuss repeat results. On univariate analysis, Asian race, hyperparathyroidism, female sex, increased age, and private insurance were associated with increased likelihood of guideline-concordant care (P<.05). Barriers identified by the social needs screener were not associated with likelihood of metabolic evaluation. Conclusion: A very small subset (3.6%) of patients in this high-risk population receive best-practice care based on AUA Guidelines. Prospective study is necessary to develop interventions to address barriers to care.