A major study coordinated by the Duke Clinical Research Institute tested whether a behavioral hydration program could help prevent kidney stones from recurring, according to a March 19 announcement. The research, published in The Lancet, involved 1,658 adolescents and adults at six U.S. clinical centers and is described as the largest behavioral study ever conducted for kidney stone prevention.
Kidney stones affect one in eleven people in the United States, with nearly half experiencing a recurrence. The study matters because it addresses the ongoing challenge of preventing these painful episodes that often disrupt daily life and lead to emergency hospital visits.
Participants were randomly assigned either standard care or a behavioral hydration program that included Bluetooth-enabled smart water bottles to measure fluid intake, personalized hydration goals called “fluid prescriptions,” financial incentives, reminder texts, and health coaching. Despite these supports, researchers found that while participants in the program did increase their average urine output, the increase was not enough to reduce symptomatic kidney stone recurrence across the group.
Charles Scales, M.D., corresponding and co-senior author of the paper and associate professor at Duke University School of Medicine, said: “The trial results show that despite the importance of high fluid intake to prevent stone recurrence, achieving and maintaining very high fluid intake is more challenging than we often assume for people with urinary stone disease.” Scales added: “The challenge of adherence likely contributes to the relatively high rate of stone recurrence in people with this chronic condition.”
Gregory E. Tasian, M.D., co-senior author and principal investigator at Children’s Hospital of Philadelphia, said: “Across adolescents and adults, the study moves the field toward more precise prevention.” Tasian continued: “Rather than asking every patient to meet the same fluid goal, we should determine who benefits from which targets, understand why adherence breaks down, and build interventions — behavioral and medical — that reliably reduce stone recurrence.”
Alana Desai, M.D., first author of the study and principal investigator at Washington University in St. Louis site said: “Kidney stone disease is a chronic condition, punctuated by unpredictable, sometimes excruciatingly painful episodes that can disrupt work, sleep, productivity and life in general.” Desai also said: “Most people would appreciate a simple means to reduce their chances of experiencing another event.”
Researchers noted this was the first large-scale trial measuring actual kidney stone recurrence using regular surveys and imaging rather than just tracking fluid intake or urine output. They highlighted how difficult it is for many people to drink large amounts of fluids daily even with structured support programs. The findings suggest future strategies may need more individualized hydration targets based on factors like age or lifestyle.
Duke University Hospital coordinated this research effort. Located in Durham, North Carolina and founded in 1925 under its current president Craig T. Albanese,the hospital admitted over 41,000 patients for treatment during 2022.
