Related Experiment Video
Updated: Sep 17, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Treatment Deferral and Coping Mechanisms Associated With Nephrolithiasis-related Financial Toxicity
Jackson J Cabo1, Rochelle Kofman2, Christopher Ballantyne1
1Department of Urology, Mayo Clinic Arizona, Phoenix, AZ.
Objective:
To assess how financial toxicity may impact the risk of deferral of recommended therapy in nephrolithiasis patients.
Methods:
We performed a nationwide cross-sectional survey of adult volunteers with kidney stone disease registered with ResearchMatch. Comprehensive Score for Financial Toxicity (COST-FACIT) score <21 was used to identify patients with nephrolithiasis-related financial toxicity. Coping mechanisms, dietary, and medical interventions for stone disease were compared between high/low financial toxicity groups. Multivariable logistic regression assessed characteristics associated with deferral of recommended medical or surgical interventions in the preceding year.
Results:
Of 945 respondents with nephrolithiasis, 205 (21.6%) reported disease-related financial toxicity (COST ≤ 20). Individuals with financial toxicity were more likely to defer recommended medical (28.3% vs 3.8%; P <.001) or surgical therapy (22.4% vs 3.4%; P <.001) for stones in the preceding year and were more likely to cite cost concerns as barriers to following nutritional recommendations (Table 1). On multivariable analysis, after controlling for income and emergency presentation for stones, higher COST-FACIT score (lower financial burden) was associated with lower odds of deferring recommended medicines or surgery for stone disease (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.87-0.92; P <.001).
Conclusion:
In this nationwide cross-sectional study, patients with kidney stones and associated financial toxicity were more likely to defer recommended surgical and medical therapy. Cost concerns were commonly cited reasons for not following medical, surgical, or dietary recommendations, highlighting a need to integrate this information into discussion of preventative interventions.
Insights
Financial toxicity significantly increases the likelihood of patients with kidney stones deferring recommended medical and surgical treatments. Cost concerns are a major barrier to adhering to medical, surgical, and dietary advice for stone disease management.
Area of Science:
- Nephrology
- Health Economics
- Patient Outcomes
Background:
- Nephrolithiasis (kidney stone disease) management involves medical, surgical, and dietary interventions.
- Financial toxicity, a measure of the impact of treatment costs on a patient's life, is an understudied factor in adherence to nephrolithiasis care.
- Understanding financial barriers is crucial for equitable and effective patient management.
Purpose of the Study:
- To evaluate the association between financial toxicity and the deferral of recommended therapies in patients with nephrolithiasis.
- To identify the extent to which cost concerns influence treatment adherence in kidney stone patients.
Main Methods:
- A nationwide cross-sectional survey was conducted with adult nephrolithiasis patients using ResearchMatch.
- Financial toxicity was assessed using the Comprehensive Score for Financial Toxicity (COST-FACIT), with scores <21 indicating significant financial toxicity.
- Multivariable logistic regression analyzed factors associated with deferring medical or surgical interventions.
Main Results:
- Over 21% of surveyed patients (205/945) reported nephrolithiasis-related financial toxicity.
- Patients with financial toxicity were significantly more likely to defer recommended medical (28.3%) or surgical (22.4%) therapy compared to those without.
- Cost concerns were frequently cited as barriers to adhering to nutritional recommendations.
Conclusions:
- Financial toxicity is a significant barrier to recommended medical and surgical treatment adherence in patients with kidney stones.
- Addressing cost concerns is essential for improving preventative interventions and treatment adherence in nephrolithiasis care.
- Integrating financial toxicity assessment into clinical discussions can improve patient outcomes.
Related Concept Videos
01:30Urinary Tract Calculi III: Medical Management
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:28Urinary Tract Calculi V: Nursing Management
01:25Urinary Tract Calculi VI: Surgical Management
01:16Kidney Transplant III: Nursing Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations