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New England Section of the American Urological Association

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Multidisciplinary Stone Clinic May be Associated with Equalizing Urine Volume Irrespective of Socioeconomic Status
Ji Whae Choi, BA1, Timothy K. O'Rourke, Jr., MD1, Frances Kazal, BA1, Kathleen Wu, BA1, Rebecca Ortiz, BA2, Philip Caffery, PhD2, Christopher T. Tucci, MS1, Jie Tang, MD1, Mary Lynch-Delaney, RD, LDN2, Gyan Pareek, MD, FACS1, David W. Sobel, MD1.
1Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA.

Background: Poor fluid intake and associated low urine volume (<2 L) on 24-hour urine collection are known risk factors for nephrolithiasis. Kidney stone risk is higher in certain demographics, and low 24-hour urine volumes have been associated with certain socioeconomic status such as low-income. We aimed to compare 24-hour urine volumes amongst high-risk stone formers followed in a multidisciplinary stone clinic (MSC) where patients are seen by urologists, nephrologists, and dietitians in one patient encounter.
Methods: A retrospective review of patient records at a single academic medical center MSC was conducted. Patient demographics (race/ethnicity, gender assigned at birth, insurance status, and religious status) and 24-hour urinary volume were collected. Urine volumes of patients who completed multiple 24-hour urine collections were averaged to produce one mean urine volume per patient. T-tests and ANOVA were used for statistical analysis to assess for differences between groups.
Results: A total of 117 patients were included in the analysis with an overall mean 24-hour urine volume of 1,980+-684 mL. No significant difference was detected between white and non-white patients (1,893+-754 mL versus 1,977+-671 mL respectively, p=0.645) and between female and male patients (1,917+-757 mL vs 2,019+-577 mL respectively, p=0.409). Patients with Medicare, Medicaid, and private insurance had similar urine volumes (1,851+-562 mL vs 1,882+-673 mL vs 2,018+-713 mL respectively, F(2,114)=0.641, p=0.529). Christian, Jewish, and non-religious groups had similar urine volumes (1,974+-667 mL vs 2,082+-675 mL vs 1,811+-873 mL respectively, F(2,114)=0.327, p=0.722).
Conclusions: There were no significant differences in 24-hour urine volume among patients from different socioeconomic status related to race/ethnicity, gender assigned at birth, insurance, and religion. Although previous studies suggest an increased risk for kidney stones in certain demographics, this study demonstrates that an MSC model may optimize the patientsí risk factors for stone formation irrespective of their socioeconomic status. Thus, clinicians should consider the potential benefit of a multidisciplinary approach in stone formers across all social determinants of health. Further investigations are necessary to characterize the impact of MSC in different populations.


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