Internal Medicine and Nephrology, Kidney Stone Center Zurich, Klinik Im Park, Bellariastrasse 38, 8038, Zurich, Switzerland.
Urolithiasis. 2017 Aug;45(4):363-370. doi: 10.1007/s00240-016-0916-3. Epub 2016 Aug 29.
Nothing is known about how well stone formers understand physician's explanations of stone formation, and a few data are available on adherence to provided recommendations. In this study, two groups of recurrent calcium stone formers (RCSFs) were compared. Group 1: 153 consecutive RCSF (118 men, 35 women) referred 1/2011-6/2014. At least 3 months after a 60-75 min consultation explaining metabolic evaluation and therapeutic measures, RCSF received a questionnaire by mail, regarding understanding of stone formation and adherence to therapeutic recommendations (diet, lifestyle, drug treatment). Response rate was 62 %. Group 2 (control): 81 consecutive RCSFs referred 7/2014-3/2016 (60 men, 21 women) were asked to answer the same questionnaire in the stone center while waiting for their follow-up consultation 3 months after starting prevention; response rate was 100 %. Alkali citrate was prescribed in 45 %. Answer sheets were analyzed anonymously, and frequencies of answers were compared by Chi-square test.
67 % (group 1) and 62 % (group 2) indicated >80 % understanding of the given information (NS). Over 80 % adherence to recommendations occurred in 26 and 30 % (NS). Most frequent changes in dietary/lifestyle habits were increases in calcium (93 vs. 89 %) and fluid intakes (81 vs. 78 %); lowering psychosocial stress (23 vs. 24 %) was least popular. Adherence to 100 % on 6-7 days/week was significantly more frequent for medication than for dietary/lifestyle interventions, both in group 1 (84 vs. 24 %, p < 0.001) and group 2 (91 vs. 28 %, p < 0.001).
(1) results do not differ whether RCSFs are voluntarily participating by mail or asked to answer questionnaires in the stone clinic; (2) pathophysiologic explanations of stone disease are understood to >80 % by 2/3 of RCSFs; (3) after 3 months, perfect adherence to recommended treatment is more frequent on alkali citrate than on dietary/lifestyle measures; and (4) increasing calcium and fluid intake are the most popular dietary measures.
本研究比较了两组复发性钙结石形成者（RCSF）。方法：1 组：153 例连续 RCSF（118 例男性，35 例女性）于 2011 年 1 月至 2014 年 6 月就诊。在解释代谢评估和治疗措施的 60-75 分钟咨询后至少 3 个月，RCSF 通过邮件收到一份问卷，内容涉及对结石形成的理解和对治疗建议（饮食、生活方式、药物治疗）的依从性。回复率为 62%。2 组（对照组）：81 例连续 RCSF 于 2014 年 7 月至 2016 年 3 月就诊，在开始预防后 3 个月等待随访时，在结石中心回答相同的问卷，回复率为 100%。处方碱式柠檬酸钙 45%。匿名分析答题纸，用卡方检验比较答案频率。结果：1 组（67%）和 2 组（62%）>80%的患者表示理解所给信息（NS）。26%和 30%的患者>80%的患者依从建议（NS）。饮食/生活方式习惯最常见的改变是增加钙（93%比 89%）和液体摄入（81%比 78%）；降低心理社会压力（23%比 24%）最不受欢迎。1 组（84%比 24%，p<0.001）和 2 组（91%比 28%，p<0.001）中，药物治疗的依从性为 100%，每周 6-7 天，显著高于饮食/生活方式干预。结论：（1）RCSF 通过邮件自愿参与或在结石诊所回答问卷，结果无差异；（2）2/3 的 RCSF 对结石病的病理生理学解释>80%；（3）3 个月后，碱式柠檬酸钙推荐治疗的依从性明显高于饮食/生活方式措施；（4）增加钙和液体摄入是最受欢迎的饮食措施。
