Structured Abstract

Contents

• Errata
• Preface
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Executive Summary
• Introduction
  • Definition of Nephrolithiasis
  • Epidemiology of Nephrolithiasis
  • Clinical Presentation of Nephrolithiasis
  • Laboratory Evaluation of Nephrolithiasis
  • Prevention of Recurrent Stone Disease
  • Purpose of Comparative Effectiveness Review
  • Analytic Framework and Key Questions
• Methods
  • Topic Refinement
  • Comparative Effectiveness Review
  • Criteria for Inclusion/Exclusion of Studies in the Review
  • Population(s)
  • Interventions
  • Searching for the Evidence: Strategies for Identifying Relevant Studies
  • Data Abstraction and Data Management
  • Assessment of Methodological Quality of Individual Studies
  • Data Synthesis
  • Strength of Evidence for Key Questions
  • Assessing Applicability
• Results
  • Key Question 1 In adults with a history of nephrolithiasis, do results of baseline stone composition and blood and urine chemistries predict the effectiveness of diet and/or pharmacological treatment on final health outcomes and intermediate stone outcomes, and reduce treatment adverse effects?
  • Key Question 2 In adults with a history of nephrolithiasis, what is the effectiveness and comparative effectiveness of different dietary therapies on final health outcomes and intermediate stone outcomes?
  • Key Question 3 In adults with a history of nephrolithiasis, what is the evidence that dietary therapies to reduce risk of recurrent stone episodes are associated with adverse effects?
  • Key Question 4 In adults with a history of nephrolithiasis, what is the effectiveness and comparative effectiveness of different pharmacological therapies on final health outcomes and intermediate stone outcomes?
  • Key Question 5 In adults with a history of nephrolithiasis, what is the evidence that pharmacological therapies to reduce risk of recurrent stone episodes are associated with adverse effects?
  • Key Question 6 In adults with a history of nephrolithiasis being treated to prevent stone recurrence, do results of followup blood and urine biochemistry measures predict final health outcomes and intermediate stone outcomes?
• Discussion
  • What Is the Evidence That Treatments Reduce Risk of Kidney Stone Recurrence?
  • What Is the Evidence That Stone Characteristics and Baseline Biochemistry Results Predict Effectiveness of Treatment To Reduce Risk of Recurrent Stones?
  • What Is the Evidence That Biochemistry Results Measured After Beginning Treatment Predict Treatment Effectiveness in Reducing Subsequent Risk of Recurrent Stones?
  • Applicability
• Future Research Recommendations
• References
• Acronyms and Abbreviations
• Appendix A Search Strategy
• Appendix B Excluded Studies
• Appendix C Evidence Tables
• Appendix D Primary Stone Recurrence Outcomes Tables
• Appendix E Secondary Stone Recurrence Outcomes Tables
• Appendix F Baseline Characteristics Summary Tables
• Appendix G Withdrawals and Adverse Events Tables
• Appendix H Baseline and Followup Urine Biochemical Measures Tables
• Appendix I References

Revised March 2013 and May 2013

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. 290-02-0009, Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, MN

Suggested citation:

Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R, Rutks IR, Brasure M, Kane RL, Monga M. Recurrent Nephrolithiasis in Adults: Comparative Effectiveness of Preventive Medical Strategies. Comparative Effectiveness Review No. 61. (Prepared by the University of Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 12-EHC049-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2012. Revised March 2013 and May 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Minnesota Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0009). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products or actions may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

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