MEDICAL REDUCTION OF STONE RISK IN A NETWORK OF TREATMENT CENTERS COMPARED TO A RESEARCH CLINIC

Purpose: We determined whether a network of 7 comprehensive kidney sto ne treatment centers supported by specialized stone management softwar e and laboratory resources could achieve reductions in urine supersatu ration comparable to those in a single research clinic devoted to meta bolic stone prevention. Materials and Methods: Supersaturation values for calcium oxalate, calcium phosphate and uric acid in 24-hour urine samples were calculated from a set of kidney stone risk factor measure ments made at a central laboratory site for the network and research l aboratory for the clinic. Individual results and group outcomes were p resented to each center in time sequential table graphics. The decreas e in supersaturation with treatment was compared in the network and cl inic using analysis of variance. Results: Supersaturation was effectiv ely reduced in the network and clinic, and the reduction was proportio nal to the initial supersaturation value and increase in urine volume. The clinic achieved a greater supersaturation reduction, higher fract ion of patient followup and greater increase in urine volume but the t reatment effects in the network were, nevertheless, substantial and si gnificant. Conclusions: Given proper software and laboratory support, a network of treatment centers can rival but not quite match results i n a dedicated metabolic stone research and prevention clinic. Therefor e, large scale stone prevention in a network system appears feasible a nd effective.