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UPJ INSIGHT Potential for Urolithiasis-related Research Using the Novel Medicare-Litholink Database

By: Noah A. Krampe, BS, University of Michigan Medical School, Ann Arbor; Mary K. Oerline, MS, University of Michigan Medical School, Ann Arbor; John R. Asplin, MD, Litholink Corporation, Laboratory Corporation of America Holdings, Itasca, Illinois; Ryan S. Hsi, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Joseph J. Crivelli, MD, University of Alabama at Birmingham Heersink School of Medicine; Vahakn B. Shahinian, MD, University of Michigan Medical School, Ann Arbor; John M. Hollingsworth, MD, MS, University of Michigan Medical School, Ann Arbor | Posted on: 20 Apr 2023

Krampe NA, Oerline MK, Asplin JR, et al. Potential for urolithiasis-related research using the novel Medicare-Litholink database. Urol Pract. 2023;10(2):146-153.

Study Need and Importance

Currently, there is a lack of large databases that contextualize the state of urolithiasis care and the use of 24-hour urine collection tests for the diagnosis and treatment of kidney stone patients with urinary metabolic abnormalities. To overcome this data availability hurdle, we linked Medicare claims data with 24-hour urine collection results from a large cohort of adults with urolithiasis. This database contains the sample size, clinical granularity, and long-term follow-up needed to study urolithiasis on a broad level.

What We Found

This novel linkage resulted in a cohort of 11,460 patients who performed 18,922 urine collections over a 5-year period. Most patients were male (57%), White (93.2%), and lived in a metropolitan county (51.5%). The most common urine abnormality in the cohort was abnormal urine pH (77.2%), followed by low urine volume (63.8%), and hypocitraturia (45.6%). Thirty percent of patients were prescribed preventive pharmacological therapy within 180 days after their first 24-hour urine collection. At 2 years of follow-up, 23.1% of patients had a symptomatic stone event either as surgery, emergency department visit, or hospitalization (see Figure).

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Figure. Frequency of symptomatic stone events by urine abnormality. ED indicates emergency department.

Limitations

First, the average age of this cohort is high (69.1). Though urolithiasis is a disease that commonly affects the elderly, this cohort may not be fully representative of the urolithiasis population in the United States. Second, this database lacks stone composition data and prevents us from answering questions about how effective medical or dietary therapy is at preventing specific types of stones.

Interpretation for Patient Care

We successfully linked Medicare claims with results from 24-hour urine collections performed by adults that were processed by Litholink. The resulting database is a unique resource for future studies on the clinical effectiveness of stone prevention strategies and urolithiasis care, more broadly.

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