Kidney stone specialist David S. Goldfarb, MD, clinical chief of nephrology at New York University Langone Medical Center in New York, pointed out the ACP's guidelines suggest that evidence for the efficacy of increasing fluid intake is weak and leave an impression that increasing fluid intake is not an important prescription for patients with kidney stones. “We know that it is an extremely important prescription, not just because it's efficacious, but because it's inexpensive and because it's safe,” Dr. Goldfarb said.
Randomized controlled trials have already provided convincing evidence of the safety and efficacy of increasing fluid intake, he said. Adding in what is understood about urine chemistry, “we know that increasing fluid intake leads to a reduction in supersaturation.”
The notion that more studies are needed to confirm that increasing fluid intake can prevent kidney stones is incorrect, said Dr. Goldfarb, who is president of the ROCK [Research on Calculus Kinetics] Society and director of kidney stone prevention and treatment programs at New York Harbor VA Healthcare System.
The new study provides “additional confirmatory evidence” of the safety and efficacy of high fluid intake for preventing kidney stones, he told Renal & Urology News.
Dr. Goldfarb's usual fluid prescription for kidney stone prevention is 96 ounces per day, assuming the weather is not very hot and the patient is not exercising too much or experiencing increased bowel losses of water. He typically instructs patients to think of 96 ounces in terms of 8 × 12 (8 12-ounce or 12 8-ounce portions). “You need a way to visualize this. “It's not enough to say to people, ‘drink a lot,' you have to say what a lot means.”
The other study by Dr. Lieske and colleagues, which was presented by Majuran Perinpam, BSc, included 416 female and 293 male subjects (mean age 64.6 and 66.5 years, respectively). Results showed that urinary calcium declined with age, and levels were higher in males than females. An increase in serum creatinine caused urine calcium to decrease. Urinary oxalate excretion was greater in males despite no difference in oxalate intake, “suggesting sex differences in metabolism or other food intake,” Dr. Lieske and his collaborators wrote in a poster presentation. Urinary uric acid excretion correlated positively with body mass index and estimated glomerular filtration rate (as calculated using cystatin C). Cystatin C correlations with uric acid may relate to hyperuricemia and inflammation, according to the researchers
Randomized controlled trials have already provided convincing evidence of the safety and efficacy of increasing fluid intake, he said. Adding in what is understood about urine chemistry, “we know that increasing fluid intake leads to a reduction in supersaturation.”
The notion that more studies are needed to confirm that increasing fluid intake can prevent kidney stones is incorrect, said Dr. Goldfarb, who is president of the ROCK [Research on Calculus Kinetics] Society and director of kidney stone prevention and treatment programs at New York Harbor VA Healthcare System.
The new study provides “additional confirmatory evidence” of the safety and efficacy of high fluid intake for preventing kidney stones, he told Renal & Urology News.
Dr. Goldfarb's usual fluid prescription for kidney stone prevention is 96 ounces per day, assuming the weather is not very hot and the patient is not exercising too much or experiencing increased bowel losses of water. He typically instructs patients to think of 96 ounces in terms of 8 × 12 (8 12-ounce or 12 8-ounce portions). “You need a way to visualize this. “It's not enough to say to people, ‘drink a lot,' you have to say what a lot means.”
The other study by Dr. Lieske and colleagues, which was presented by Majuran Perinpam, BSc, included 416 female and 293 male subjects (mean age 64.6 and 66.5 years, respectively). Results showed that urinary calcium declined with age, and levels were higher in males than females. An increase in serum creatinine caused urine calcium to decrease. Urinary oxalate excretion was greater in males despite no difference in oxalate intake, “suggesting sex differences in metabolism or other food intake,” Dr. Lieske and his collaborators wrote in a poster presentation. Urinary uric acid excretion correlated positively with body mass index and estimated glomerular filtration rate (as calculated using cystatin C). Cystatin C correlations with uric acid may relate to hyperuricemia and inflammation, according to the researchers
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