IntroductionEpidemiologyI. Epidemiology of kidney stonesI.1. Prevalence of kidney stonesI.2. An increasing trend in childrenPathophysiology II. Pathophysiology of kidney stonesII.1. LithogenesisII.1.1. Urine supersaturation : the driving force of crystallogenesisII.1.2. Promoters and inhibitors of stone formationII.2. Urine volume and composition: a necessary balanceRisk factorsIII. Risk factors for kidney stonesIII.1. Individual, non-modifiable risk factorsIII.1.1 Family historyIII.1.2. Race and ethnicityIII.1.3. Age and genderIII.1.4. Current change in gender prevalenceIII.2. Lifestyle related factorsIII.2.1. Calcium intakeIII.2.2. Emerging dietary risk factorsIII.2.3. Association with other chronic diseasesDehydrationIV. Dehydration: a risk factor for kidney stonesIV.1. Low urine volume: a key risk factor for kidney stonesIV.2. Environmental factors predisposing to low urine volumeIV.2.1. Occupational risk of kidney stonesIV.2.2. Climate and temperature as risk factorsWater & recurrenceV. Prevention of stone recurrence with high water intakeV.1. Reduction of recurrence rate with increased water intakeV.2. Water intake and urinary parameters in stone formersWater & incidenceVI. Primary prevention of stones with high water intakeVI.1. Reduction of stone incidence with increased water intakeVI.2. Water intake and urinary parameters in healthy subjectsWater & health costsVII. Water intake and health costs of kidney stonesVII.1. Reduction of stone recurrence costs via adequate water intakeVII.2. Reduction of first stone costs with adequate water intakeRecommendationsVIII. Dietary and water recommendations for stone preventionVIII.1. Guidelines for the prevention of recurrence in patientsVIII.2. Dietary and water guidelines for general populationConclusion References

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Water & health costs

VII. Water intake and health costs of kidney stones

Health costs for kidney stone disease are considerable. For instance in the United States, total care for kidney stone disease was estimated to cost more than $2.1 billion for the year of 2000 alone (Pearle et al. 2005). In France, the total cost of one episode of nephrolithiasis was estimated at €4267, which corresponds to an annual budget impact of stone disease of €590 million for the French health care system (Lotan et al. 2012).

 

Prevention may represent a key economic lever. Lotan et al. studied the impact of various preventive measures, and mainly of water intake, on the reduction of health costs of kidney stones. As it appears below, they concluded that high water intake is a cost-effective measure for the prevention of kidney stones. 

VII.1. Reduction of stone recurrence costs via adequate water intake

Cost savings through secondary prevention by increased water intake were estimated on a hypothetical cohort of French stone formers. Cost savings were calculated with a Markov statistical model for an adequate water intake of 2.0L/d as compared to the French average water intake of less than 2.0L/d. Results showed that with a compliance of 100%, an adequate water intake could reduce the French health care costs by €49 million every year by preventing 11,572 new stone recurrences. Even with a compliance of only 25%, as much as 2,893 stones could be prevented and €10 million could be saved every year on recurrences (Lotan et al. 2013).

VII.2. Reduction of first stone costs with adequate water intake

Lotan et al. estimated that prevention of kidney stones through adequate water intake can be cost-effective in healthy subjects as well (see Figure 8). They showed that a compliance of 100% could save €273 million every year by preventing 9,265 first stone episodes just in France. With a compliance of 25% cost savings were still estimated at €68 million (Lotan et al. 2012). 

Diagram: Prevention of the first episode of kidney stones by increasing fluid intake - Efficacy in reducing costs based on compliance

 

Figure 8. Cost-effectiveness of high water intake to prevent first episodes of kidney stone

according to population compliance.
(Lotan et al. 2012). 

 

Take home messages

Prevention of kidney stones with an adequate water intake of 2.0L per day is cost-effective and can reduce the economic burden of urolithiasis.

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