Is there a role of hydration for first stone prevention?

Several studies suggest that chronic dehydration from different causes such as working in a hot environment or physical exertion increases the risk of stone incidence.1-5 Data suggests also that stone diseases occur more frequently in geographic areas with a hot climate. In countries such as Saudi Arabia, over 20% of the population develop renal stones whereas the risk of the disease is only 12 to 13% in North America and 5 to 10 % in Europe.There is also a seasonal variation of stone incidence, with higher rates in summer.7,8

In addition, some studies show the relationship between fluid intake and stone risk in the healthy population:

  • In two large observational studies, total fluid intake was significantly and negatively associated with the risk of renal stones.9,10
  • A three-year intervention controlled trial tested the preventive effect of an educational program on adequate fluid intake in a population living in a hot climate compared to a similar population who did not receive any advice. Results showed that the population with the educational program had a higher urine volume and a lower stone incidence than the population who were not advised on fluid intake.11

It has also recently been shown that an additional water intake of 1.3 L could decrease the theoretical risk of crystallization, the first step of stone formation, in the urine of a healthy population as measured by the Tiselius crystallization risk index.12

Nevertheless, further studies are needed to confirm the role of adequate fluid intake for first stone prevention.


  1. Embon OM, Rose GA, Rosenbaum T. Chronic dehydration stone disease. Br J Urol. 1990;66:357-62.
  2. Pin NT, Ling NY, Siang LH. Dehydration from outdoor work and urinary stones in a tropical environment. Occup Med (Lond). 1992;42:30-2.
  3. Borghi L, Meschi T, Amato F, Novarini A, Romanelli A, Cigala F. Hot occupation and nephrolithiasis. J Urol. 1993;150:1757-60.
  4. Chang MA, Goldfarb DS. Occupational risk for nephrolithiasis and bladder dysfunction in a chauffeur. Urol Res. 2004;32:41-3.
  5. Olapade-Olaopa EO, Agunloye A, Ogunlana DI, Owoaje ET, Marinho T. Chronic dehydration and symptomatic upper urinary tract stones in young adults in Ibadan, Nigeria. West Afr J Med. 2004;23:146-50.
  6. Ferrari P, Piazza R, Ghidini N, Bisi M, Galizia G, Ferrari G. Lithiasis and risk factors. UrolInt. 2007;79:8-15.
  7. Baker PW, Coyle P, Bais R, Rofe AM. Influence of season, age, and sex on renal stone formation in South Australia. Med J Aust. 1993;159:390-2.
  8. Al-Hadramy MS. Seasonal variations of urinary stone colic in Arabia. J Pak Med Assoc. 1997;47:281-4.
  9. Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J AmSocNephrol. 2004;15:3225-32.
  10. Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. ArchInternMed. 2004;164:885-91.
  11. Frank M, De Vries A. Prevention of urolithiasis. Education to adequate fluid intake in a new town situated in the Judean Desert Mountains. ArchEnvironHealth. 1966;13:625-30.
  12. De La Guéronnière V, Le Bellego L., Buendia Jimenez I, Dohein O, Tack I, Daudon M. Increasing water intake by 2 liters reduces crystallization risk indexes in healthy subjects. ArchItalUrolAndrol. 2011;83:43-50.

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