Water intake and kidney stones

 

 

Kidney stones, also called urolithiasis, are a common pathology affecting about 10% of the population in developed countries at least once in an individual’s lifetime. Recent trends show an increase in stone prevalence.

The role of dietary habits, including fluid intake, has a great implication in stone development.

A cross section of a kidney

Hydration: A well recognized role in recurrence prevention

The role of increased fluid intake as a means of preventing recurrence of kidney stones is well recognized today. In fact, it has been used since the time of Hippocrates.
Adequate fluid intake helps to decrease concentrations of substances involved in stone formation thus reducing their saturation degree in urine (a necessary condition for crystallization, and a first step towards stone formation).
Many studies have shown the beneficial effects of improved fluid intake (and consequently urine volume) on stone recurrence prevention.

The strongest scientific evidence certainly comes from a five-year randomized controlled trial conducted amongst patients recruited directly after their first idiopathic calcium stone episode. This study showed that recommending patients to increase fluid intakes to achieve a urine volume superior to 2L per day resulted in reduced kidney stone recurrence compared to a group without specific advice.1

The European Association of Urology2 recommends increasing fluid intake independent of the type of stones to achieve a urine volume of more than 2L a day, on top of other dietary and lifestyle advice.

 

Recommendations to lower the risk of kidney stones2

table on general preventive measures

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.3-7 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.8 There is also a seasonal variation of stone incidence, with higher rates in summer.9-10

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.11-12
  • 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.13

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.14

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

References:

  1. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155:839-43.
  2. Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C. Guidelines on Urolithiasis, European Association of Urology 2011. 
  3. Embon OM, Rose GA, Rosenbaum T. Chronic dehydration stone disease. Br J Urol. 1990;66:357-62.
  4. Pin NT, Ling NY, Siang LH. Dehydration from outdoor work and urinary stones in a tropical environment. Occup Med (Lond). 1992;42:30-2.
  5. Borghi L, Meschi T, Amato F, Novarini A, Romanelli A, Cigala F. Hot occupation and nephrolithiasis. J Urol. 1993;150:1757-60.
  6. Chang MA, Goldfarb DS. Occupational risk for nephrolithiasis and bladder dysfunction in a chauffeur. Urol Res. 2004;32:41-3.
  7. 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.
  8. Ferrari P, Piazza R, Ghidini N, Bisi M, Galizia G, Ferrari G. Lithiasis and riskfactors. UrolInt. 2007;79:8-15.
  9. 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.
  10. Al-Hadramy MS. Seasonal variations of urinary stone colic in Arabia. J Pak Med Assoc. 1997;47:281-4.
  11. 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.
  12. 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.
  13. 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.
  14. 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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