Thomas Kaleb, Ganesan Calyani, Liu Sai, Thomas I-Chun, Montez-Rath Maria E, Soerensen Simon John Christoph, Chertow Glenn M, Leppert John T, Pao Alan C
Department of Medicine, Stanford University School of Medicine, Stanford, California.
Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Kidney360. 2025 Feb 1;6(2):296-302. doi: 10.34067/KID.0000000639. Epub 2024 Nov 19.
Only 6% of patients with urinary stone disease visit a nephrology clinic within 6 months of a stone event in the Veterans Health Administration. Nephrology care within 6 months of a stone event can vary by as much as 72% across different Veterans Health Administration facilities. Efforts to increase access to nephrology, in addition to urology, may improve quality of health care to patients with urinary stone disease.
Prevention is a cornerstone for the management of recurrent urinary stone disease. Current guidelines recommend metabolic evaluation, lifestyle modification, and medical treatment of patients with urinary stone disease. Nephrologists are uniquely qualified to evaluate stone risk and formulate treatment strategies to reduce that risk. The objective of this study was to determine the frequency of nephrology visits after a urinary stone diagnosis, a key window of opportunity to assess stone risk.
We used nationwide data from the US Veterans Health Administration to identify patients who had an incident stone diagnosis between 2016 and 2018. We examined the proportion of patients who visited a nephrology clinic within 6 months of stone diagnosis.
We identified 42,927 veterans with urinary stone disease. Only 2432 (5.6%) visited a nephrology clinic within 6 months of the index diagnosis. The proportion of patients who visited a nephrology clinic after their stone diagnosis ranged between 0.7% and 20.7% across 104 Veterans Health Administration sites, with a median of 4.6% (25%–75% range, 3.4%–7.0%). The median rate ratio for a nephrology follow-up visit after a stone diagnosis was 1.72. Veterans with CKD were significantly more likely to visit a nephrology clinic relative to veterans without CKD (odds ratio, 5.19; 95% confidence interval, 4.69 to 5.74).
Nephrologists are infrequently and variably involved in the care of patients after a urinary stone diagnosis, suggesting potential for quality improvement.
在退伍军人健康管理局（Veterans Health Administration），仅有6%的尿石症患者在结石事件发生后的6个月内前往肾病科就诊。在不同的退伍军人健康管理局机构中，结石事件发生后6个月内的肾病护理差异高达72%。除泌尿科外，增加肾病科就诊机会的努力可能会改善尿石症患者的医疗质量。
预防是复发性尿石症管理的基石。当前指南建议对尿石症患者进行代谢评估、生活方式调整和药物治疗。肾病科医生在评估结石风险和制定降低该风险的治疗策略方面具有独特的资质。本研究的目的是确定尿石症诊断后肾病科就诊的频率，这是评估结石风险的关键机会窗口。
我们使用了美国退伍军人健康管理局的全国性数据，以识别2016年至2018年间首次诊断为结石的患者。我们检查了在结石诊断后6个月内前往肾病科就诊的患者比例。
我们识别出42927名患有尿石症的退伍军人。仅有2432名（5.6%）在索引诊断后的6个月内前往肾病科就诊。在104个退伍军人健康管理局机构中，结石诊断后前往肾病科就诊的患者比例在0.7%至20.7%之间，中位数为4.6%（四分位间距，3.4%至7.0%）。结石诊断后肾病科随访就诊的中位数率比为1.72。与无慢性肾脏病（CKD）的退伍军人相比，患有CKD的退伍军人前往肾病科就诊的可能性显著更高（优势比，5.19；95%置信区间，4.69至5.74）。
肾病科医生在尿石症诊断后对患者的护理中参与较少且存在差异，这表明有质量改进的潜力。
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