A new study from the Urinary Stone Disease Research Network, coordinated by the Duke Clinical Research Institute, reports on Mar. 19 that behavioral hydration programs are not sufficient to prevent the recurrence of kidney stones.
The findings are important because kidney stones affect one in eleven people in the United States, with nearly half experiencing a recurrence. The study aimed to determine if structured support could help people drink enough fluids to lower their risk of developing new stones.
Participants in the trial were randomly assigned either standard care or a behavioral hydration program that included Bluetooth-enabled smart water bottles, personalized fluid goals, financial incentives, reminder texts, and health coaching. The goal was for participants to reach a urine output of at least 2.5 liters per day. While those in the program did increase their average urine output, this was not enough to reduce symptomatic kidney stone recurrence across the group.
Charles Scales, M.D., corresponding and co-senior author and associate professor at Duke University School of Medicine, said: "The trial results show that despite the importance of high fluid intake to prevent stone recurrence, achieving and maintaining very high fluid intake is more challenging than we often assume for people with urinary stone disease." Scales also said: "The challenge of adherence likely contributes to the relatively high rate of stone recurrence in people with this chronic condition."
Researchers followed 1,658 adolescents and adults at six U.S. clinical centers over two years. The study design was notable for measuring actual stone recurrence using regular surveys and imaging rather than just tracking fluid intake or urine output.
Gregory E. Tasian, M.D., co-senior author and principal investigator at Children's Hospital of Philadelphia, said: "Across adolescents and adults, the study moves the field toward more precise prevention." Tasian added: "Rather than asking every patient to meet the same fluid goal, we should determine who benefits from which targets, understand why adherence breaks down, and build interventions - behavioral and medical - that reliably reduce stone recurrence."
Alana Desai, M.D., first author and principal investigator at Washington University in St. Louis study site said: "Kidney stone disease is a chronic condition, punctuated by unpredictable, sometimes excruciatingly painful episodes that can disrupt work, sleep, productivity and life in general." Desai continued: "Most people would appreciate a simple means to reduce their chances of experiencing another event."
Researchers concluded that new approaches may be needed for prevention strategies tailored to individual needs as well as potential therapies that help keep minerals dissolved in urine.
