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Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets.
Am J Kidney Dis. 2014 Mar; 63(3):456-63.AJ

Abstract

BACKGROUND

Patients with nephrolithiasis and hyperoxaluria generally are advised to follow a low-oxalate diet. However, most people do not eat isolated nutrients, but meals consisting of a variety of foods with complex combinations of nutrients. A more rational approach to nephrolithiasis prevention would be to base dietary advice on the cumulative effects of foods and different dietary patterns rather than single nutrients.

STUDY DESIGN

Randomized controlled trial.

SETTING & PARTICIPANTS

Recurrent stone formers with hyperoxaluria (urine oxalate > 40 mg/d).

INTERVENTION

The intervention group was asked to follow a calorie-controlled Dietary Approaches to Stop Hypertension (DASH)-style diet (a diet high in fruit, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, sweets, and meat), whereas the control group was prescribed a low-oxalate diet. Study length was 8 weeks.

OUTCOMES

Primary: change in urinary calcium oxalate supersaturation.

SECONDARY

Changes in 24-hour urinary composition.

RESULTS

57 participants were randomly assigned (DASH group, 29; low-oxalate group, 28). 41 participants completed the trial (DASH group, 21; low-oxalate group, 20). As-treated analysis showed a trend for urinary oxalate excretion to increase in the DASH versus the low-oxalate group (point estimate of difference, 9.0mg/d; 95% CI, -1.1 to 19.1mg/d; P=0.08). However, there was a trend for calcium oxalate supersaturation to decrease in the DASH versus the low-oxalate group (point estimate of difference, -1.24; 95% CI, -2.80 to 0.32; P=0.08) in association with an increase in magnesium and citrate excretion and urine pH in the DASH versus low-oxalate group.

LIMITATIONS

Limited sample size, as-treated analysis, nonsignificant results.

CONCLUSIONS

The DASH diet might be an effective alternative to the low-oxalate diet in reducing calcium oxalate supersaturation and should be studied more.

Authors+Show Affiliations

Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Nephrology Section, New York Harbor VA Healthcare System, New York, NY; Nephrology Division, New York University School of Medicine, New York, NY.Harold Simmons Center for Kidney Disease Research & Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California, Irvine, Irvine, CA.Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: basiri@unrc.ir.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24560157

Citation

Noori, Nazanin, et al. "Urinary Lithogenic Risk Profile in Recurrent Stone Formers With Hyperoxaluria: a Randomized Controlled Trial Comparing DASH (Dietary Approaches to Stop Hypertension)-style and Low-oxalate Diets." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 63, no. 3, 2014, pp. 456-63.
Noori N, Honarkar E, Goldfarb DS, et al. Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets. Am J Kidney Dis. 2014;63(3):456-63.
Noori, N., Honarkar, E., Goldfarb, D. S., Kalantar-Zadeh, K., Taheri, M., Shakhssalim, N., Parvin, M., & Basiri, A. (2014). Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 63(3), 456-63. https://doi.org/10.1053/j.ajkd.2013.11.022
Noori N, et al. Urinary Lithogenic Risk Profile in Recurrent Stone Formers With Hyperoxaluria: a Randomized Controlled Trial Comparing DASH (Dietary Approaches to Stop Hypertension)-style and Low-oxalate Diets. Am J Kidney Dis. 2014;63(3):456-63. PubMed PMID: 24560157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets. AU - Noori,Nazanin, AU - Honarkar,Elaheh, AU - Goldfarb,David S, AU - Kalantar-Zadeh,Kamyar, AU - Taheri,Maryam, AU - Shakhssalim,Nasser, AU - Parvin,Mahmoud, AU - Basiri,Abbas, PY - 2013/08/22/received PY - 2013/11/27/accepted PY - 2014/2/25/entrez PY - 2014/2/25/pubmed PY - 2014/4/16/medline KW - Dietary Approaches to Stop Hypertension (DASH) diet KW - calcium oxalate supersaturation KW - clinical trial KW - hyperoxaluria KW - kidney stone KW - nephrolithiasis KW - oxalate SP - 456 EP - 63 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 63 IS - 3 N2 - BACKGROUND: Patients with nephrolithiasis and hyperoxaluria generally are advised to follow a low-oxalate diet. However, most people do not eat isolated nutrients, but meals consisting of a variety of foods with complex combinations of nutrients. A more rational approach to nephrolithiasis prevention would be to base dietary advice on the cumulative effects of foods and different dietary patterns rather than single nutrients. STUDY DESIGN: Randomized controlled trial. SETTING & PARTICIPANTS: Recurrent stone formers with hyperoxaluria (urine oxalate > 40 mg/d). INTERVENTION: The intervention group was asked to follow a calorie-controlled Dietary Approaches to Stop Hypertension (DASH)-style diet (a diet high in fruit, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, sweets, and meat), whereas the control group was prescribed a low-oxalate diet. Study length was 8 weeks. OUTCOMES: Primary: change in urinary calcium oxalate supersaturation. SECONDARY: Changes in 24-hour urinary composition. RESULTS: 57 participants were randomly assigned (DASH group, 29; low-oxalate group, 28). 41 participants completed the trial (DASH group, 21; low-oxalate group, 20). As-treated analysis showed a trend for urinary oxalate excretion to increase in the DASH versus the low-oxalate group (point estimate of difference, 9.0mg/d; 95% CI, -1.1 to 19.1mg/d; P=0.08). However, there was a trend for calcium oxalate supersaturation to decrease in the DASH versus the low-oxalate group (point estimate of difference, -1.24; 95% CI, -2.80 to 0.32; P=0.08) in association with an increase in magnesium and citrate excretion and urine pH in the DASH versus low-oxalate group. LIMITATIONS: Limited sample size, as-treated analysis, nonsignificant results. CONCLUSIONS: The DASH diet might be an effective alternative to the low-oxalate diet in reducing calcium oxalate supersaturation and should be studied more. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24560157/Urinary_lithogenic_risk_profile_in_recurrent_stone_formers_with_hyperoxaluria:_a_randomized_controlled_trial_comparing_DASH__Dietary_Approaches_to_Stop_Hypertension__style_and_low_oxalate_diets_ DB - PRIME DP - Unbound Medicine ER -