{"title":"Adherence to medical management of kidney stones: A systematic review.","authors":"Bassel Salka, Rami Barqawi, Sarosh Irani, Mustapha Jaber, Mohammad Jafri, Naveen Kachroo","doi":"10.1007/s00240-026-02066-2","DOIUrl":null,"url":null,"abstract":"<p><p>The effectiveness of dietary and pharmacologic stone prevention strategies may be limited by poor patient adherence. This systematic review aims to assess adherence to the American Urological Association (AUA) guidelines for medical management of kidney stone disease by (1) determining how adherence influences clinical outcomes, (2) identifying which preventive interventions demonstrate the highest adherence, and (3) characterizing factors associated with adherence. A systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, and Embase were searched from database inception through January 1, 2026, using terms related to nephrolithiasis and patient adherence/compliance. Studies involving adults with prior kidney stones reporting adherence to dietary, pharmacologic, or metabolic evaluation-based prevention were included. Dual-reviewer screening and standardized data extraction were performed. No protocol was prospectively registered. Of 909 identified studies, 35 met inclusion criteria, comprising 57,970 patients. Across studies, greater adherence consistently correlated with decreased subsequent stone related events. Increased fluid intake demonstrated the highest lifestyle adherence (~ 65-85%), while thiazide diuretics showed the greatest pharmacologic adherence (43-87%), exceeding citrate therapy and dietary modification. Adherence to metabolic evaluation and longitudinal follow-up testing was relatively low. Predictors of improved adherence included older age, higher education and socioeconomic status, prior stone events, and greater disease severity. Traditional physician counseling has a positive relationship on adherence to medical management. Adherence to guideline-based kidney stone prevention strongly influences clinical outcomes. Tailored counseling and prevention plans informed by patient and disease characteristics are critical to improve effectiveness of stone prevention therapy.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urolithiasis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00240-026-02066-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
The effectiveness of dietary and pharmacologic stone prevention strategies may be limited by poor patient adherence. This systematic review aims to assess adherence to the American Urological Association (AUA) guidelines for medical management of kidney stone disease by (1) determining how adherence influences clinical outcomes, (2) identifying which preventive interventions demonstrate the highest adherence, and (3) characterizing factors associated with adherence. A systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, and Embase were searched from database inception through January 1, 2026, using terms related to nephrolithiasis and patient adherence/compliance. Studies involving adults with prior kidney stones reporting adherence to dietary, pharmacologic, or metabolic evaluation-based prevention were included. Dual-reviewer screening and standardized data extraction were performed. No protocol was prospectively registered. Of 909 identified studies, 35 met inclusion criteria, comprising 57,970 patients. Across studies, greater adherence consistently correlated with decreased subsequent stone related events. Increased fluid intake demonstrated the highest lifestyle adherence (~ 65-85%), while thiazide diuretics showed the greatest pharmacologic adherence (43-87%), exceeding citrate therapy and dietary modification. Adherence to metabolic evaluation and longitudinal follow-up testing was relatively low. Predictors of improved adherence included older age, higher education and socioeconomic status, prior stone events, and greater disease severity. Traditional physician counseling has a positive relationship on adherence to medical management. Adherence to guideline-based kidney stone prevention strongly influences clinical outcomes. Tailored counseling and prevention plans informed by patient and disease characteristics are critical to improve effectiveness of stone prevention therapy.
期刊介绍：
Official Journal of the International Urolithiasis Society
The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field.
Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.
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