Clinical Report: SMART Stone MDT Guidelines for Adult High-Risk Kidney Stone Patients

Overview

The SMART Stone multidisciplinary team (MDT) approach provides consensus-based recommendations for managing adult high-risk recurrent kidney stone formers. A panel of international experts achieved ≥70% agreement on 44 recommendations covering MDT formation, patient identification, assessment, and care integration, emphasizing improved patient outcomes through coordinated multidisciplinary care.

Background

Kidney stone disease prevalence has increased over the past three decades, with high-risk recurrent stone formers experiencing significant morbidity and reduced quality of life. Managing this multifactorial condition requires integration of medical, surgical, biochemical, and genetic expertise. Multidisciplinary teams (MDTs) have proven beneficial in complex diseases by enhancing diagnosis, treatment adherence, and outcomes, yet guidelines for MDT implementation in kidney stone disease have been lacking. The SMART Stone project aimed to fill this gap by developing expert consensus recommendations for MDT formation and function in adult high-risk stone patients.

Data Highlights

Panel composition: Core survey responders (n=29) from 19 countries; Extended survey responders (n=15) from 14 countries. Panelists included urologists, nephrologists, and biochemists/geneticists.

Key Findings

• All 44 recommendations for MDT implementation in managing high-risk kidney stone patients reached consensus with ≥70% agreement.
• Core recommendations (13 total) had very high agreement, with 12 achieving ≥90% consensus, highlighting key priorities for MDT establishment.
• Extended recommendations (31 total) also achieved consensus, with 22 reaching ≥90% agreement, particularly in communication, decision-making, onward referral, and care integration.
• Team composition and defining roles had the lowest agreement among extended recommendations but still met the consensus threshold.
• 93% of core survey responders agreed that MDTs improve therapeutic management and patient journey in complex stone disease.
• Recommendations emphasize early identification, referral, and comprehensive assessment of high-risk stone formers within an MDT framework.

Clinical Implications

Implementing a SMART Stone MDT can optimize care for adult patients with complex recurrent kidney stones by fostering collaboration among urologists, nephrologists, biochemists, and geneticists. Early identification and coordinated management within an MDT setting may reduce morbidity, improve quality of life, and streamline resource utilization. Clinicians should adapt these consensus recommendations to their local healthcare infrastructure and resource availability to maximize patient benefit.

Conclusion

The SMART Stone MDT consensus provides a structured framework to guide multidisciplinary management of adult high-risk kidney stone formers. Adoption of these recommendations promises improved patient outcomes through coordinated, comprehensive care.

References

1. SMART Stone Steering Committee et al. 2024 -- Guidelines for Managing Adult High-Risk Kidney Stone Patients: Insights from the SMART Stone Multidisciplinary Team Approach