Study Aims to Standardize Kidney Stone Treatment

Cases of kidney stones are on the rise among children.

As the incidence of pediatric kidney stones rises, Children’s of Alabama is joining forces with the Pediatric KIDney Stone Care Improvement Network (PKIDS) to gain knowledge on patient-centered outcomes and comparative effectiveness data on kidney stone treatment and surgery to improve outcomes that are most important to patients.

PKIDS is a collaborative community of patients, caregivers, clinicians and researchers from 26 pediatric health care systems in the U.S. Through a prospective cohort study, the network is comparing stone clearance, re-treatment and unplanned health care encounters in children who receive surgical interventions as part of their clinical care. The goal is to enroll 1,300 patients throughout the country. “This is by far the largest pediatric stone study that’s been published to date,” Children’s pediatric urologist Carmen Tong, D.O., said.

Children’s is particularly well suited to participate in this study given that Alabama sits in what’s known as the “stone belt” for its higher incidence and prevalence of kidney stones. “It’s a pretty big economic and public health burden,” Tong said.

“There have not been any good studies looking at care for children with kidney stones, including patient and parent experiences with children needing kidney stone surgery,” Tong said. “Then there are issues with access to care, compliance with follow-up care and prevention of kidney stones. While these issues have been well studied in adults, our understanding in children is limited.” In fact, current guidelines for managing pediatric kidney stones are minimal and dated, she said. “This study is supposed to help change the paradigm and come up with a uniform, standardized algorithm on treatment of kidney stones.”

It’s not clear what’s driving the increased prevalence of stones in children, Tong said. Causes could be dietary (e.g., sugary drinks, high sodium) and/or hereditary, but climate change could also be a culprit, she said. “There are studies looking at weather-related causes. In the summer, when it’s hotter and children drink less water, the incidence rises.” Certain medications, like antibiotics, also increase the risk. Children are 50% more likely than adults to have recurrence within three years.

Families in the study complete a series of surveys about their and their child’s experiences with kidney stones and surgery. “We want to get from the parent and patient standpoint how they’re dealing with their kidney stones,” Tong said. On the clinical side, investigators will get a comprehensive view of how stones are treated around the country, including which surgical interventions were used and when.

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