Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Urol. 2018 Dec;200(6):1290-1294. doi: 10.1016/j.juro.2018.06.023. Epub 2018 Jun 18.
To our knowledge it is unknown whether the benefits of medical management of urolithiasis outweigh the potential side effects of the medications used, including potassium citrate and thiazide diuretics. Therefore, we evaluated the relationship between potassium citrate or thiazides and overall stone related health related quality of life.
Cross-sectional data were obtained on stone forming enrollees in the North American Stone Quality of Life Consortium. We used the WISQOL (Wisconsin Stone Quality of Life) questionnaire to compare health related quality of life between patients treated and not treated with potassium citrate or thiazide type diuretics. Additionally, the likelihood of gastrointestinal complaints was compared between those prescribed and not prescribed potassium citrate. The likelihood of fatigue and sexual complaints was also compared in those prescribed and not prescribed thiazides.
Of the 1,511 subjects, including 787 males and 724 females, 279 were on potassium citrate and 238 were on thiazides at study enrollment. Patients prescribed potassium citrate had higher health related quality of life in each domain vs those not prescribed potassium citrate (p <0.001). Patients prescribed thiazides had higher health related quality of life in each domain compared to those not prescribed thiazide (all p <0.01). Those prescribed potassium citrate were less likely than those not prescribed potassium citrate to report nausea, stomach upset or cramps (OR 0.57, p <0.001). Patients prescribed thiazides were less likely than those not prescribed thiazides to report fatigue (OR 0.63, p = 0.004) or reduced sexual interest and/or activity (OR 0.64, p = 0.005).
Among stone formers the use of potassium citrate and thiazides was associated with better health related quality of life across all WISQOL domains without an increased likelihood of gastrointestinal complaints and fatigue or sexual complaints, respectively. These findings may be useful when counseling patients regarding the initiation of potassium citrate or thiazides for medical management of nephrolithiasis.
据我们所知，尚不清楚治疗尿石症的医学管理的益处是否超过了所用药物（包括枸橼酸钾和噻嗪类利尿剂）的潜在副作用。因此，我们评估了枸橼酸钾或噻嗪类药物与整体结石相关健康相关生活质量之间的关系。
我们从北美结石生活质量联盟的结石形成者中获得了横断面数据。我们使用 WISQOL（威斯康星结石生活质量）问卷来比较接受和未接受枸橼酸钾或噻嗪类利尿剂治疗的患者的健康相关生活质量。此外，还比较了开枸橼酸钾处方和不开枸橼酸钾处方患者之间胃肠道投诉的可能性。还比较了开噻嗪类药物和不开噻嗪类药物处方患者的疲劳和性功能障碍投诉的可能性。
在 1511 名受试者中，包括 787 名男性和 724 名女性，279 名受试者正在服用枸橼酸钾，238 名受试者正在服用噻嗪类药物。与未开枸橼酸钾处方的患者相比，开枸橼酸钾处方的患者在每个领域的健康相关生活质量都更高（p<0.001）。与未开噻嗪类药物处方的患者相比，开噻嗪类药物处方的患者在每个领域的健康相关生活质量都更高（均 p<0.01）。与未开枸橼酸钾处方的患者相比，开枸橼酸钾处方的患者报告恶心、胃部不适或痉挛的可能性较小（OR 0.57，p<0.001）。与未开噻嗪类药物处方的患者相比，开噻嗪类药物处方的患者报告疲劳（OR 0.63，p=0.004）或减少性兴趣和/或活动（OR 0.64，p=0.005）的可能性较小。
在结石形成者中，使用枸橼酸钾和噻嗪类药物与所有 WISQOL 领域的健康相关生活质量改善相关，而胃肠道投诉、疲劳或性功能障碍投诉的可能性均无增加。在为肾结石的医学管理开始使用枸橼酸钾或噻嗪类药物时，这些发现可能对患者咨询有用。
