Category: Epidemiology, Health Policy, Socioeconomics & Outcomes

MP28-3 - Income is strongly associated with kidney stone disease-specific quality of life

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Kidney stones are a source of significant morbidity and have been shown to negatively impact health-related quality of life (HRQOL). While socioeconomic status (SES) is associated with HRQOL, it has never been examined in relation to kidney stone disease-specific HRQOL. The purpose of this study was to assess kidney stone patients’ quality of life in relation to income.

Methods :

This was a multi-institutional prospective cohort study where kidney stone patients at 10 stone centers across the U.S. were enrolled. They completed the Wisconsin Stone Quality of Life questionnaire (WISQOL – a validated HRQOL questionnaire specifically tailored to kidney stone patients) between June 2014 and March 2017 at the time of their first clinic visit when presenting for initial stone evaluation. Race/ethnicity was defined by self-report. Each patient’s income was estimated using census median incomes identified by zip code, then further classified into low, middle, and upper income brackets using Pew Research Center guidelines. Linear regression was used to examine the relationship between income and HRQOL, adjusting for age, gender, race, BMI, number of stone events, and number of comorbidities.

Results :

The study sample included 1,777 individuals. Older age and male gender were significantly associated with higher WISQOL scores (p<0.010). Factors associated with lower WISQOL scores were low income, non-White race, overweight or extremely obese BMI, the presence of 3 or more comorbidities, and severe recurrent stone formation. In a multiple regression model, the effect of income on QOL weakened but remained statistically significant (p<0.050, Table 1).

Conclusions :

Lower income, when adjusted for age, race, gender, BMI, number of stone events, and comorbidities, is statistically significantly associated with lower stone-specific HRQOL. Understanding how SES impacts HRQOL may lend insight into ways to optimize the management of patients with kidney stones.

Thomas Chi

Associate Professor
San Fransisco, California

Thomas Chi, MD
Associate Professor
Associate Chair for Clinical Affairs
Kutzmann Endowed Professor for Clinical Urology
UCSF Department of Urology

Dr. Thomas Chi, MD, graduated as a President's Scholar from Stanford University with a BA in Human Biology and MAs in Sociology and Music. He earned his MD from the University of California, San Francisco where he also completed urology residency and a fellowship in Endourology and Laparoscopy under the mentorship of Dr. Marshall L. Stoller.

During his fellowship, Dr. Chi was awarded grant funding from the National Institutes of Health and the American Urological Association Urology Care Foundation to research the fundamental mechanisms underlying the formation of urinary stones.

Clinical Interests

He joined the UCSF faculty of the Department of Urology in 2013 where his clinical interests include the care of patients with urinary stone disease and those in need of minimally invasive surgery. He specializes in the performance of endoscopic, laparoscopic, and percutaneous surgeries as well as HoLEP. He has established ReSKU, the Registry for Stones of the Kidneys and Ureter, the first kidney stone registry of its kind for tracking patient clinical outcomes and is an internationally recognized specialist in the use of ultrasound in the management of kidney stones to minimize patient radiation exposure.

Research Interests

In addition to his clinical interests, Dr. Chi supervises an NIH-funded translational science lab where he leads a cross-disciplinary research team. His research focuses on understanding the genetic and microbial environment of the kidney related to how kidney stones form and developing new medical preventative interventions. He has developed a novel model fruit fly for the study of kidney stones and has published over 80 peer-reviewed articles and book chapters spanning both basic science as well as epidemiologic approaches centered around improving the care of patients with urinary stone disease.

David T. Tzou

Assistant Professor
University of Arizona
Tucson, Arizona

Tessnim Ahmad

UCSF Department of Urology
San Francisco, California

Shalonda Reliford-Titus

UCSF Department of Urology
San Francisco, California

Clinton Wu

UCSF Department of Urology
San Francisco, California

Jeremy Goodman

UCSF Department of Urology
San Francisco, California

Jodi Antonelli

Assistant professor urology
UT Southwestern
Dallas, Texas

Jodi Antonelli, M.D. is an Assistant Professor in the Department of Urology at UT Southwestern Medical Center. She specializes in the medical and surgical management of kidney stone disease.
Dr. Antonelli earned her medical degree from Jefferson Medical College of Thomas Jefferson University. She completed a general surgery internship and a urology residency at Duke University Medical Center. She completed a fellowship in endourology and stone disease in the Department of Urology at UT Southwestern.
Her research interests include evaluation of dietary and medical therapies for kidney stone prevention, assessment of outcomes for minimally invasive surgical treatments, and development and assessment of surgical innovation. She was the recipient of the 2014 Elisabeth Pickett Research Award for the Society of Women in Urology.
Dr. Antonelli is a member of the American Urological Association, the Endourological Society, and ROCK Society.

Davis Viprakasit

Associate Professor of Urology
University of North Carolina
Chapel Hill, North Carolina

Timothy Averch

Chief, Division of Urology
Palmetto Health - University of South Carolina
University of South Carolina
Columbia, South Carolina

Sri Sivalingam

Staff Urologist
Cleveland Clinic Foundation
Cleveland, Ohio

Sri Sivalingam MD, MSc, FRCSC, is assistant professor of surgery at Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. He is Director of the Center for Endourology and Stone Disease at Cleveland Clinic’s Hillcrest Hospital. Originally from Canada, he earned his Bachelors, Masters, and Medical degrees at the University of Toronto, and subsequently completed his urology residency at the University of Manitoba. He then completed a two-year fellowship in advanced Endourology and Minimally Invasive Surgery with a strong focus on urinary stone disease at the University of Wisconsin. He is board certified by both the American Board of Urology and the Royal College of Physicians and Surgeons of Canada.

Dr. Sivalingam's primary surgical, clinical, research and teaching interests include the treatment and prevention of urinary stone disease with several peer reviewed publications in this area. He is the co-director of the endourology research group and the fellowship program in stone disease at the Cleveland Clinic.

Ben H. Chew

Associate Professor, Department of Urologic Sciences
University of British Columbia
Vancouver, British Columbia, Canada

Dr. Chew is a urologist and the Director of Clinical Research at the Stone Centre at Vancouver General Hospital and an Associate Professor of Urology at the University of British Columbia in Vancouver, Canada. His main interests lie in the treatment and research of the pathophysiology of kidney stone disease. His research focus includes metabolic stone disease as well as biomaterials used in the urinary tract for ureteral stents. He has worked on various stent designs, stent coatings and drug-eluting ureteral stents to try and improve the quality of life for patients with kidney stone disease. He continues work on a degradable ureteral stent and has completed the first-in-human trials. Current studies include attempting to understand second messenger systems that are activated within the kidney and ureter once a ureteral stent has been placed. These could be exploited as future therapeutic targets for new drug eluting ureteral stents or designs to reduce symptoms.
He has authored over 80 peer-reviewed manuscripts and book chapters. He is a member of the Endourologic Disease Group for Excellence (EDGE) research consortium ( and the Wisconsin Quality of Life (WISQoL) research consortium. Dr. Ben Chew is also the Chair of Research for the Endourology Society. The role of the Research Chair is to facilitate and help improve research for the entire society.

Vincent G. Bird

Professor of Urology
University of Florida College of Medicine, Department of Urology
Gainseville, Florida

Dr. Vincent G. Bird is currently Professor in the Department of Urology, Chief of the Division of Minimally Invasive Surgery, the endourology and minimally invasive surgery fellowship program co-director, and associate program director of the residency program in the Department of Urology at the University of Florida College of Medicine. Dr. Bird completed his fellowship training in robotics, laparoscopy and endourology at the University of Iowa Hospitals and Clinics. At the conclusion of his fellowship, Dr. Bird was recognized for excellence in clinical science by the Endourological Society for research relating to patterns of treatment for urinary stone disease.
Dr. Bird received his undergraduate education at Boston University, and attended medical school at the State University of New York, Stony Brook, where he received his medical degree with distinction in research and was also awarded for his work involving cellular processes related to cancer and inflammation. Dr. Bird then completed his general surgical and urological training at the University of Miami. Currently, his clinical practice focuses on renal surgery for urinary stone disease, renal obstruction, and renal cancer, while his clinical and basic science research focus is on the treatment of a variety of renal conditions. He also has publications and interests relating to urologic imaging. He has contributed publications on treatment of urinary stone disease with newly developed technologies.
Dr. Bird is also an active member of the American Urological Association, Southeastern Section of the American Urological Association, Endourological Society, and past president of the Florida Urological Society. Dr. Bird has held a number of positions within the Florida Urologic Society, serving two terms as scientific director as well as secretary treasurer. He serves as a reviewer for a number of Urology based journals.

Vernon Pais

Associate Professor, Associate Program Director
Lebanon, New Hampshire

Vernon Pais is an endourologist with clinical and research focuses on urolithiasis. He is an associate professor at the Geisel School of Medicine at Dartmouth and serves as the director of urologic research and associate program director for the urology residency at Dartmouth.

Necole M. Streeper

Assistant Professor of Surgery
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania

Roger L. Sur

Professor of Urology
UC San Diego Department of Urology
San Diego, California

Stephen Y. Nakada

University of Wisconsin School of Medicine and Public Health, Department of Urology
Madison, Wisconsin

Stephen Y. Nakada, MD, FACS is Professor and founding Chairman of the Department of Urology and the David T. Uehling Chair of Urology at the University of Wisconsin School of Medicine and Public Health in Madison, WI. He received his medical degree from the University of Rochester School of Medicine and Dentistry, and completed his residency training at Strong Memorial Hospital in Rochester, NY. Dr. Nakada went on to complete his Endourology Fellowship at Washington University prior to joining the faculty at the University of Wisconsin in 1995. Dr. Nakada has been the Chairman of Urology in Madison since 2001.

Dr. Nakada's research focuses on urolithiasis and renal aspects of minimally invasive urology. He has authored or co-authored over 200 scientific articles, 50 book chapters, and he has edited more than 10 textbooks in those areas. In 2004, Dr. Nakada received the Gold Cystoscope Award and in 2017 he received the Distinguished Service Award from the AUA. He is currently an editorial consultant for Urology Times and an Assistant Editor of the Journal of Endourology.

Dr. Nakada has served as President of the R.O.C.K. Society, Society of Academic Urologists and the Endourological Society. He has served on the AUA Staghorn Stone and Ureteral Stones Guidelines Committees, the AUA/ABU Examination Committee, and he served as the Chair of the AUA Laparoscopy & Robotic Surgery Committee. Currently, Dr. Nakada is President of the American Board of Urology and a member of the Advisory Council in Urology to the American College of Surgeons. Dr. Nakada is an active member of the American Association of Genitourinary Surgeons and the Clinical Society of Genitourinary Surgeons, among other societies.

Kristina L. Penniston

Senior Scientist
University of Wisconsin School of Medicine and Public Health, Department of Urology
Madison, Wisconsin

Kristina Penniston is a scientist and registered dietitian nutritionist in Madison, Wisconsin. Dr. Penniston earned her PhD in nutritional science from the University of Wisconsin-Madison. She completed a dietetic internship at the University of Wisconsin Hospital and Clinics and is a certified dietitian member and fellow of the Academy of Nutrition and Dietetics. Dr. Penniston has provided clinical nutrition services to patients with kidney stones and other urologic diseases, such as urologic cancer and benign urologic conditions, for 20 years. Dr. Penniston's research in the Department of Urology at the University of Wisconsin School of Medicine and Public Health focuses on prevention of kidney stones. Specifically, her research aims to develop and test dietary interventions that prevent or ameliorate recurrent stones; promote patients' self-efficacy in managing their stone disease; and understand and improve patients’ health-related quality of life. Dr. Penniston has developed a porcine model of dietary-induced calcium oxalate urolithiasis as a platform for studying dietary influences on stone formation. She also helped to develop the Wisconsin Stone Quality of Life questionnaire, a stone-specific instrument to assess patients' health-related quality of life. Dr. Penniston is a member of the American Urological Association and is a former research scholar (2008-2010). She has been a member of the Research on Calculus Kinetics (ROCK) Society since 2008 and was elected in 2018 as secretary/treasurer. Dr. Penniston publishes regularly in urologic and nutrition journals.