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The effect of medication use on stone-related quality of life
Eric P. Raffin, MD1, Kristina L. Penniston, RD2, Rebecca Smith, MS1, Lawrence Dagrosa, MD1, Jodi A. Antonelli, MD3, Davis P. Viprakasit, MD4, Timothy D. Averch, MD5, Vincent G. Bird, MD6, Ben H. Chew, MD7, Sri Sivalingam, MD8, Roger L. Sur, MD9, Stephen Y. Nakada, MD2, Vernon M. Pais, MD1.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 3University of Texas Southwestern Medical Center, Dallas, TX, USA, 4University of North Carolina School of Medicine, Chapel Hill, NC, USA, 5University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 6University of Florida College of Medicine, Gainesville, FL, USA, 7University of British Columbia Department of Urologic Sciences, Vancouver, BC, Canada, 8Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA, 9University of California San Diego School of Medicine, San Diego, CA, USA.
BACKGROUND: Potassium citrate and thiazide diuretics have well-established roles in the medical management of stone disease. While a reduction in stone proclivity is desirable and may improve health-related quality of life (HRQOL), this benefit must be weighed against potential risk of unwanted side effects, including nausea, fatigue and sexual dysfunction. It is not currently well understood how the use of these medications affects patients’ HRQOL. We sought to evaluate whether the use of potassium citrate or thiazides reduces a patient’s stone-related HRQOL.
METHODS: Utilizing the previously validated Wisconsin Stone-QOL questionnaire (WISQOL), a kidney stone-specific instrument, we analyzed cross-sectional data from patients both new to and already established in stone prevention, enrolled at sites participating in the North American Stone QOL Consortium. We compared HRQOL in the WISQOL domains of social impact, emotional impact, disease impact, and vitality between patients treated and those not treated with either potassium citrate or thiazides using student’s t-test. Additionally, univariate and multivariate logistic regression were used to assess likelihood of complaints of nausea and stomach upset or cramps between those prescribed and not prescribed potassium citrate. This was also done to assess the likelihood of complaints of fatigue and reduced sexual interest/activity between those prescribed and not prescribed thiazides.
RESULTS: 1511 stone formers were included (787 male, 724 female), of whom 258 were on potassium citrate and 207 on a thiazide at study enrollment. Patients prescribed potassium citrate scored significantly higher (better HRQOL) in each of the domains. With multivariate analysis, these differences maintained their significance (mean domain scores were higher by 2.5, 2.8, 2.8, 1.3 points, respectively, all p<0.0001). Patients prescribed a thiazide had significantly higher scores in each domain compared to those not prescribed a thiazide. These differences maintained significance with multivariate analysis (mean domain scores higher by 1.9, 2.3, 2.1, 1.0 points, respectively, all p<0.01). In item-level analysis, patients prescribed potassium citrate were less likely than those not prescribed to report any nausea, stomach upset or cramps (43% vs 55%, p<0.001). Multivariate logistic regression showed a 40% lower likelihood of having GI complaints among patients prescribed potassium citrate, p=0.001, when controlling for age, gender, BMI, and number of stone events. Patients prescribed thiazides were less likely than those not prescribed to report any fatigue (59% vs 68%, p=0.008). Those on thiazides were less likely to report reduced sexual interest/activity (24% vs 31%, p=0.02). On multivariate logistic regression, patients on thiazides were overall 32% less likely to report fatigue, p=0.02, and 33% less likely to report reduced sexual interest/activity, p=0.026, when controlling for the aforementioned factors.
CONCLUSIONS: Among stone formers, use of potassium citrate and thiazide diuretics is associated with higher HRQOL across all domains of the WISQOL. Specifically, those prescribed potassium citrate were less likely to endorse GI complaints compared to those not taking potassium citrate. Similarly, use and tolerance of thiazides is not associated with either fatigue or reduced sexual interest/activity. These findings may be useful when counseling patients regarding initiation of potassium citrate or thiazides for medical management of stones.
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