Abstract / Summary
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.