Advancing Early Careers and Surgical Outcomes Research in Kidney Stone Disease

By Kate Knab

As the incidence of kidney stone disease in the pediatric population rapidly grows, with studies showing an annual rise between 4% and 10%, there is an increasing need for upcoming generations of curious, talented urologists seeking answers to new patient questions.

Funding through the Personalizing Outcomes of Nephrolithiasis in Youth (PONY) P20 Center will leverage data collected through Children’s Hospital of Philadelphia-led research and data networks to support the growth of two early-career investigators as they focus on research that will improve understanding of outcomes for children who have kidney stones and have undergone surgery.

“The initiative offers a unique synergy in accelerating the research of others and generating knowledge that is going to impact patients’ health,” said Gregory Tasian, MD, MSc, MSCE, an attending urologist and Director of the Pediatric KIDney Stone (PKIDS) Care Improvement Network at CHOP. “By creating a pathway for early-stage investigators, we are magnifying the impact of research that's done at CHOP.”

The unique funding mechanism by the National Institute of Diabetes and Digestive and Kidney Diseases is designed to advance the careers of early-stage investigators by partnering them with established principal investigators. As the lead principal investigator for PONY, Dr. Tasian will facilitate research studies conducted by Jonathan Ellison, MD, Associate Director of the PKIDS Network and a pediatric urologist at Children’s Wisconsin, and David Chu, MD, MSCE, a former CHOP fellow and an attending urologist at Lurie Children’s Hospital of Chicago. With access to robust data sets and the rich research infrastructure at CHOP, Drs. Ellison and Chu will generate results that could help them to apply for future R01 funding.

“At the end of this grant, the urology research community will have two additional well-trained and talented investigators who are uniquely poised to answer the most meaningful questions for children with kidney stone disease,” Dr. Tasian said.

The researchers will analyze data collected from trials led by Dr. Tasian such as PKIDS, Prevention of Urinary Stones with Hydration, and STudy to Enhance uNderstanding of sTent-associated Symptoms, and from the national patient-centered research network PCORnet®. This research network will pull in electronic health data and clinical trial data from participating sites including PEDSnet, which is coordinated at CHOP.

Drs. Ellison and Chu will conduct distinct but complementary research studies to answer an unmet patient need in benign urology research.

Jonathan Ellison, MD

Currently, doctors do not have a way to discern who could develop a painful event and when it will occur in children and youths who have non-obstructing asymptomatic kidney stones. Dr. Ellison is working to develop a prediction model of future symptomatic stone events, which will better determine which asymptomatic patients may benefit from surgical removal of stones and which may be safely watched. He will be following patients who have stones remaining after undergoing surgery to eventually link their long-term outcomes in the PEDSnet and PCORnet® databases.

“Patients and caregivers have expressed to us the importance of understanding the best management for non-obstructing kidney stones,” Dr. Ellison said. “These data will inform counseling and management strategies for an aspect of kidney stone disease that greatly impacts the experiences of patients and their families.”

David Chu, MD, MSCE

Dr. Chu will focus on patients who receive stents — temporary drainage tubes that connect the kidney and bladder — while they undergo surgery for kidney stone removal. Which patients will experience pain related to the stents, the type of discomfort, and the length of pain are all highly variable. Dr. Chu will analyze data collected from the PKIDS trial from more than 800 patients who underwent kidney stone removal surgery to characterize persistent symptoms that could identify potential candidates for clinical trials and improve real-time patient counseling.

"Knowing ahead of time which individuals are most at risk of experiencing severe stent-related symptoms has been difficult but essential, as the most commonly performed surgeries for treating kidney stones often involve stent placement,” Dr. Chu explained. “Early identification of these patients and their risk factors will help facilitate earlier interventions to improve their postoperative experience.”

In addition to directly improving care for patients, a secondary goal of the PONY P20 grant, according to Dr. Tasian, is to combat structural and scientific barriers that have been challenging the progression of urology research specialized in surgical outcomes. Surgeons are substantially underrepresented in research portfolios, due, in part, to a lack of models for academic surgeons that include research careers. By partnering with early-career investigators to share knowledge and experiences, Dr. Tasian hopes to inspire future generations of investigators who are excited about surgical research.