The impact of smart technology on adherence rates and fluid management in the prevention of kidney stones.

Abstract

Smart technology (ST) can enhance chronic disease management, yet little is known about the benefits of ST on kidney stone prevention. Our aim was to prospectively evaluate the impact of ST on follow-up adherence rates and urine output (UOP) in patients with nephrolithiasis. Kidney stone patients with low UOP (< 2.5L/24h) were randomized into three intervention groups: (1) standard dietary/medical counseling alone (control), (2) control + smartphone fluid management application (app), and (3) control + smart water bottle (bottle). Demographics, adherence rates, kidney stone events, and 24h urine data were collected and analyzed at baseline, 3-6, and 12months. We randomized 111 patients (37 per group), of which 20 (55%), 8 (26%), and 10 (33%) patients completed the 12month follow-up in the control, app, and bottle groups respectively. Control group patients were the most likely to adhere to follow-up (p = 0.004). Overall mean UOP increased by 0.4L in each group (p < 0.05), with no difference in mean baseline 24h UOP (1.6L) and 12month 24h UOP (2.0L) between groups (p > 0.05). Twenty-nine percent of patients achieved a daily UOP goal of > 2.5L across the treatment groups (p < 0.001). In this prospective study, the 24h UOP improved across all groups compared to baseline, although adherence to follow-up remained low. Furthermore, the use of ST did not further augment UOP, underscoring the importance of dietary/medical counseling for kidney stone prevention.