From stones to system: integrating kidney stones disease into the cardiovascular-kidney-metabolic continuum

To reposition kidney stone disease within the cardiovascular-kidney-metabolic continuum and synthesize recent evidence on therapeutics, clinician-supervised digital monitoring, and value-based care implementation to modernize prevention and follow-up.

Epidemiology shows a rise in kidney stone disease prevalence across cardiovascular-kidney-metabolic stages independent of demographics. Comparative-effectiveness analyses suggest fewer stone events with sodium-glucose cotransporter-2 inhibitor(s) vs. active comparators, while early randomized data demonstrate meaningful reductions in urinary supersaturation in phenotype-matched stone formers. Digital hydration programs using validated connected bottles and just-in-time prompts increase 24-h urine output in feasibility studies; at-home urine pH and urine conductivity measurement offer pragmatic proxies for day-to-day risk. However, clinical validation, privacy governance, and regulatory readiness of software-as-a-medical-device remain variable.

Embedding kidney stone disease prevention within a cardiovascular-kidney-metabolic program supports value-based outcomes. A hybrid "Care, Remote Monitoring, Medication optimization, Nudges pathway" links early risk identification to telemonitoring and titration. Integrating urinary lithogenic profiling into cardiovascular-kidney-metabolic screening flags asymptomatic patients with lithogenic profiles before a first stone, enabling prevention of stones and chronic kidney disease progression. Priorities consist in validation of digital urinary biomarkers (time-in-target volume/pH) and deployment of hybrid care. This patient-centred hybrid model can shift current episodic procedures to anticipatory, measurable, and scalable prevention within routine cardiovascular-kidney-metabolic care.