image: Ryan Hsi, MD, associate professor in the Department of Urology, Division of Endourology and Stone Disease at Vanderbilt University Medical Center.
Credit: Vanderbilt University Medical Center
Kidney stone disease research is the focus of a five-year, $7.37 million National Institutes of Health (NIH) RC2 grantawarded to Vanderbilt University Medical Center and led by Vanderbilt urologist Ryan Hsi, MD, and Children’s Hospital of Philadelphia pediatric urologist Gregory Tasian, MD.
The project will create the Urinary Stone Disease Hub, known as USDHub, with de-identified patient data from over 230,000 individuals with kidney stone disease across nine health systems in the U.S.
USDHub will combine medical expertise across adult and pediatric urology and nephrology, informatics and AI to establish a novel, accessible and usable data resource. It will include clinically important information from CT images, clinical notes, stone composition, and 24-hour urine labs, which are not available in existing databases.
“This project is centered on improving the research infrastructure and community around kidney stone disease,” said Hsi, associate professor in the Department of Urology, Division of Endourology and Stone Disease.
“Kidney stone disease is very common, affecting approximately 11% of the U.S. population and increasingly affecting children and adolescents. Some of the critical barriers for improving the health of patients with kidney stone disease are that existing research resources lack clinically important information and longitudinal data and/or that it is difficult to assess, or not freely available to researchers,” Hsi said.
The work also will highlight the collaborative relationships between VUMC and Vanderbilt University, through the use of the ImageVU resource, led by Bennett Landman, PhD, Stevenson Chair of Engineering and professor of Electrical and Computer Engineering.
“We have worked with amazing collaborators across VU and VUMC to develop image-processing technologies to perform 3D mapping of individual patients' kidneys without changing current clinical practices,” said Landman, also an associate professor of Radiology and Radiological Sciences.
“The USDHub will transform kidney research through massive-scale mapping of 3D kidney anatomy across the lifespan, with nine clinical sites and over 200,000 patients. Our extended team’s combined efforts will provide rich new insights into the causes and potential interventions for kidney stones,” he said.
The other seven sites involved are part of the STAR and PEDSnet, which are two PCORnet research networks that have standardized electronic health record data. They include University of North Carolina, Medical University of South Carolina, Duke University, Texas Children’s Hospital, Nationwide Children’s Hospital, Lurie Children’s Hospital of Chicago and Cincinnati Children’s Hospital.
“The key aspect of this is that it will include individuals across the lifespan,” said Hsi, the co-principal investigator for the project. “We will also include input from patients and caregivers to the design and dissemination of USDHub to make sure it has the highest value to the community.”
Stone disease is one of the most common conditions seen by urologists, but the research is also relevant across medical institutions in areas including primary care, emergency medicine and nephrology, and is increasingly a condition seen at children’s hospitals.
VUMC has a dedicated Stone Center at the Vanderbilt Health Belle Meade location, offering comprehensive care from diagnosis to treatment to prevention. Additionally, Vanderbilt offers the MyUrologyHealth Bundle for the treatment of kidney stones, which is a novel episode-related service so that patients have little or no out-of-pocket expenses.
“We live in the ‘stone belt’ in the South and the prevalence of stone disease is higher here based on environmental and lifestyle factors,” Hsi said. “We know that stone disease is more common in warmer climates; it is also linked to diabetes, obesity and metabolic syndrome, which are common in the Southeast U.S.”
Even though about 1 in 11 Americans report having a kidney stone in their lifetime, there is evidence that many people have kidney stones and don’t even know it. Up to 10-15% of people will find out they have kidney stones when they get a CT for an unrelated reason like screening for cancer, Hsi said.
When a kidney stone becomes symptomatic, it can be incredibly life disrupting, Hsi said. It can occur out of the blue with intense pain and require urgent care or ER visits. Many stones pass, while others may require surgery. “Some patients will have urinary tract infections, and for others there could be a negative impact on kidney function. Beyond that, we also know that stone disease impacts quality of life by being a source of anxiety and stress for patients who have it,” he added.
Within this context, USDHub aims to accelerate research that will lead to highly impactful and clinically meaningful discoveries for individuals with kidney stones. A key component of the project will be broadly disseminating the resource to research communities to maximize USDHub’s impact.
“This study has the potential to make a real difference in the lives of people who suffer from kidney stones,” said David Penson, MD, professor and chair of Urology. “It speaks to Dr. Hsi’s leadership and commitment to improving clinical care in this common condition. We’re all very proud of Ryan for this work.”
The research is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (grant 1RC2DK140865-01).