Practice patterns of kidney stone management across European and non-European centers: an in-depth investigation from the European Renal Stone Network (ERSN)

Abstract

Rationale and objective Kidney stones are a common condition in the general population, however, high-quality evidence for its management is scarce. We propose the creation of an international network with the aim of sharing practice patterns and patient data towards an improvement of our knowledge of the disease. Study design Cross-sectional survey. Setting and participants An online survey was circulated through several scientific societies. Items were grouped into six domains. Each center’s overall score (OS) was also calculated. Analytical approach Chi square and Mann–Whitney tests were performed for differences across centers. Results The countries that contributed most were Italy (8.6%), Turkey (6.6%), France and Spain (6.1%). Some type of nutritional work-up was implemented in 62% of centers. A DEXA scan was performed by 46% of centers, whereas some kind of acidification test was performed by 25% of centers. Most centers (80%) implemented blood investigations at least at baseline. With regard to 24-h urine exams, 7 out of 16 were performed by at least 50% of centers. Information on stone composition was collected by 58% of centers. The OS was significantly higher among higher-volume centers compared with lower-volume centers (p = 0.002). Significant differences between EU and non-EU centers were found. Limitations Cross-sectional design; no validation on information. Conclusions Our survey highlights the potential for the creation of a network of centers that could share information in a common database for observational research and for enrollment of patients in interventional trials.

Diagnostic policies on nephrolithiasis/nephrocalcinosis of possible genetic origin by Italian nephrologists: a survey by the Italian Society of Nephrology with an emphasis on primary hyperoxaluria

“…Most patients with stones were referred to the Nephrologist by their primary care physician or urologist. These findings confirm what was reported in a survey recently conducted among European Nephrologists and Urologists [ 4 ]. Similar considerations can be drawn for the cases of nephrocalcinosis observed by the participating Nephrologists.…”

“…The majority of these Nephrologists refer their stone patients for metabolic screening, thus complying with the recommendations of the most important guidelines [ 5 , 6 ]. This finding, which confirms what has already been observed in Europe [ 4 ], is opposite to what has been observed in the United States, where only 15% [ 7 ] of stone patients undergo 24-h urine collection, a 'proxy' for metabolic studies. The difference probably lies in the fact that the U.S. study likely investigated a population seen by a mix of specialists (e.g., not only Nephrologists), unlike our survey, which was conducted only among Nephrologists, and the European survey, in which 78.5% of respondents were Nephrologists.…”

“…The results of this survey in the “Nephrology” section, although based on a non-random sample almost exclusively consisting of Nephrologists (96%), appear to be well representative of the broader European Nephrology community [ 4 ]. We therefore assume that the data collected on the clinical management of patients with hyperoxaluria are also representative of the standard practice.…”

The epidemiology of kidney stones in Belgium based on Daudon’s morpho-constitutional classification: a retrospective, single-center study

“…Our results highlight the need for field-specific standardization of clinical protocols in terms of stone assessment procedures, as well as in defining clinically relevant metadata including MCC type and physical composition of stones considering the initiative of European Renal Stone Network for a common database for observational research [94,95].…”

Stone Prevention: Dietary Factors, Current Evidence, and Metabolic Workup

“…The first step in stone prevention is to identify the cause in an individual patient. Ferraro et al [33] shared interesting datum concerning the practice patterns in various European and non-European centers. In this survey, the authors noted that a basic blood workup is performed in most patients and nutritional advice and stone composition analysis are carried out in a significant proportion.…”