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Ferraro PM. et al., 2019: A preliminary survey of practice patterns across several European kidney stone centers and a call for action in developing shared practice

Ferraro PM, Arrabal-Polo MÁ, Capasso G, Croppi E, Cupisti A, Ernandez T, Fuster DG, Galan JA, Grases F, Hoorn EJ, Knauf F, Letavernier E, Mohebbi N, Moochhala S, Petkova K, Pozdzik A, Sayer J, Seitz C, Strazzullo P, Trinchieri A, Vezzoli G, Vitale C, Vogt L, Unwin RJ, Bonny O, Gambaro G.
U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italy.Università Cattolica del Sacro Cuore, Roma, Italy. Lithotripsy and Endourology Unit, Department of Urology, San Cecilio University Hospital, Granada, Spain.Division of Nephrology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.USL Toscana Centro, Florence, Italy.Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.Service of Nephrology, University hospital of Geneva, Geneva, Switzerland.Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.Urolithiasis and Endourology Unit, General University Hospital, Alicante, Spain.Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research, Palma de Mallorca, Spain.Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus medical center, Rotterdam, The Netherlands.Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.Sorbonne Universités, UPMC Univ Paris 06, UMR Division of Nephrology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.Kidney and Urology Centre, Royal Free Hospital, London, UK.
Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria.
Nephrology Clinic, Hôpital Brugmann, Kidney Stones Clinic, Centre Hospitalier Universitaire, Université Libre de Bruxelles, Brussels, Belgium.Newcastle upon Tyne Hospitals NHS Foundation Trust, NE7 7DN, Newcastle, UK.Institute of Genetic Medicine, Newcastle University, Central Parkway, NE1 3BZ, Newcastle, UK.NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK.Department of Urology, Medical University of Vienna, Währinger Gurtel 18-20 in, 1090, Vienna, Austria. Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy. Urology Unit, Ospedale Manzoni, Lecco, Italy.Nephrology and Dialysis Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. Nephrology and Dialysis Unit, AO Ordine Mauriziano, Torino, Italy. Amsterdam Cardiovascular Sciences, Dept of Internal Medicine, section Nephrology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. Service of Nephrology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland. U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.

Abstract

Currently an evidence-based approach to nephrolithiasis is hampered by a lack of randomized controlled trials. Thus, there is a need for common platforms for data sharing and recruitment of patients to interventional studies. A first step in achieving this objective would be to share practice methods and protocols for subsequent standardization in what is still a heterogeneous clinical field. Here, we present the results of a pilot survey performed across 24 European clinical kidney stone centers. The survey was distributed by a voluntary online questionnaire circulated between June 2017 and January 2018. About 46% of centers reported seeing on average 20 or more patients per month. Only 21% adopted any formal referral criteria. Centers were relatively heterogeneous in respect of the definition of an incident stone event. The majority (71%) adopted a formal follow-up scheme; of these, 65% included a follow-up visit at 3 and 12 months, and 41% more than 12 months. In 79% of centers some kind of imaging was performed systematically. 75% of all centers performed laboratory analyses on blood samples at baseline and during follow-up. All centers performed laboratory analyses on 24-h urine samples, the majority (96%) at baseline and during follow-up. There was good correspondence across centers for analyses performed on 24-h urine samples, although the methods of 24-h urine collection and analysis were relatively heterogeneous. Our survey among 24 European stone centers highlights areas of homogeneity and heterogeneity that will be investigated further. Our aim is the creation of a European network of stone centers sharing practice patterns and hosting a common database for research and guidance in clinical care.

Urolithiasis. 2019 Jun;47(3):219-224. doi: 10.1007/s00240-019-01119-z. Epub 2019 Mar 8.

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Comentarios 1

Hans-Göran Tiselius en Viernes, 22 Noviembre 2019 09:23

This article is a survey of how stone patients currently are treated over Europe. With a dominance of nephrologists in the established network, it stands to reason that the major purpose of future projects will be to find evidence for the value of different medical treatment alternatives.

The message included in this report is that a network of this kind offers a unique possibility to address questions that so far have remained without reasonable answers. Although methods for stone removal are not particularly mentioned in the document it is obvious that a lot of valuable information can be obtained provided adequate and careful long-term plans are made. It might for instance be possible to get a good insight in the real cost of SWL as well as to increase our knowledge of the course of residual fragments with or without recurrence preventive treatment. Highly interesting would it be to see what different fragment elimination methods can offer.

So far this article does not provide any information on treatment results, but the network seems to be a superb platform for future studies if a smooth cooperation between different centres can be established and maintained. But the project is of course associated with an inherent uncertainty in the latter regard. Nevertheless the idea is very interesting and its progress deserves to be followed seriously.

This article is a survey of how stone patients currently are treated over Europe. With a dominance of nephrologists in the established network, it stands to reason that the major purpose of future projects will be to find evidence for the value of different medical treatment alternatives. The message included in this report is that a network of this kind offers a unique possibility to address questions that so far have remained without reasonable answers. Although methods for stone removal are not particularly mentioned in the document it is obvious that a lot of valuable information can be obtained provided adequate and careful long-term plans are made. It might for instance be possible to get a good insight in the real cost of SWL as well as to increase our knowledge of the course of residual fragments with or without recurrence preventive treatment. Highly interesting would it be to see what different fragment elimination methods can offer. So far this article does not provide any information on treatment results, but the network seems to be a superb platform for future studies if a smooth cooperation between different centres can be established and maintained. But the project is of course associated with an inherent uncertainty in the latter regard. Nevertheless the idea is very interesting and its progress deserves to be followed seriously.
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