Kidney stones are a painful and expensive medical problem, and people who suffer from kidney stones once are likely to experience them a second time. Recurrence can often be prevented if patients increase urine output by increasing the amount of water that they drink. Though this may seem easy, fewer than 50% of people who have suffered from kidney stones are able to drink the recommended amount of fluids.
A team of researchers at Penn State just received a five-year, $2.97 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases to address this problem. David Conroy, professor of kinesiology and human development and family studies, Necole Streeper, assistant professor of surgery at the College of Medicine, and their collaborators are developing sipIT, a technology-based intervention to promote fluid intake, increase urine output, and reduce risk of kidney stones.
“One of the best strategies for preventing kidney stones is to increase fluid intake,” Streeper said. “Clinical guidelines recommend drinking enough to produce at least 2.5 liters of urine daily. However, adherence is commonly below 50% and thirst is not sufficient to meet that goal, as people often forget to drink when they are not thirsty.
“The sipIT intervention reminds people to drink when they haven’t recently, to better adhere to daily fluid intake goals,” Streeper continued. “It provides a semi-automated way to track fluid intake and reminds patients only at times when they have not been drinking so they don’t get annoyed by unnecessary reminders.”
SipIT combines mobile, wearable, and connected technology to reduce the burden on participants. Participants use a smartphone app, smartwatch, and connected water bottle to track their fluid intake. The researchers also have developed a new algorithm that enables smartwatches to detect when someone drinks. SipIT is designed to promote habit formation so that, once people have used sipIT for a period of time, they will continue to consume fluids even without using the sipIT tools.
“Our work on sipIT is unique because it leverages evidence-based strategies from behavioral science and some of the latest digital technology to address an important clinical problem,” Conroy explained. “If patients in this trial benefit from using sipIT, it can be applied to help patients manage a number of other dehydration-related health problems and risks, such as preventing urinary tract infections, reducing the effects of heat stress for older adults, and preventing post-surgical hospital readmissions.”
This funding will allow sipIT to be refined for use in a large clinical trial, but a prototype tool has already been developed and pilot tested. The research team collaborated with two companies, Fitabase and West Arete, to create the algorithms needed for the project. The researchers also recruited people with a history of kidney stones to participate in focus groups about the design. These people provided input on which features were useful and which features were too burdensome to use regularly.
“We learned early on from focus groups with patients that there was limited interest in using some of the wearables we had in mind initially, so we focused on sensors that many people already wear on their wrist – namely, accelerometers and gyroscopes,” Conroy said. “We also learned that patients were very interested in connected water bottles. We had been completely focused on wearable sensors and hadn’t anticipated that interest. By working with patients, we were able to develop a less burdensome and more engaging tool than we would have otherwise.”
Before this project was funded by NIDDK, the researchers received financial support from Penn State’s Clinical and Translational Science Institute (CTSI) and the Social Science Research Institute.
“The Penn State CTSI Bridges to Translation Pilot Program was critical for developing this new line of research,” explained Conroy. “That support allowed us to engage patients in focus groups, to develop the algorithm for detecting drinking gestures on smartwatches, and to evaluate the feasibility of the initial sipIT intervention with patients.”
Other investigators working on this grant include, Nilam Ram, professor of communications and psychology at Stanford University, and Edison Thomaz, assistant professor of electrical and computer engineering at The University of Texas at Austin.