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Changes in urinary risk profile after short-term low sodium and low calcium diet in recurrent Swiss kidney stone formers.
BMC Nephrol 2017; 18(1):349BN

Abstract

BACKGROUND

Kidney stone disease is common in industrialized countries. Recently, it has attracted growing attention, because of its significant association with adverse renal outcomes, including end stage renal disease. Calcium-containing kidney stones are frequent with high recurrence rates. While hypercalciuria is a well-known risk factor, restricted intake of animal protein and sodium, combined with normal dietary calcium, has been shown to be more effective in stone prevention compared with a low-calcium diet. Notably, the average sodium intake in Switzerland is twice as high as the WHO recommendation, while the intake of milk and dairy products is low.

METHODS

We retrospectively analyzed Swiss recurrent kidney stone formers (rKSF) to test the impact of a low-sodium in combination with a low-calcium diet on the urinary risk profile. In patients with recurrent calcium oxalate containing stones, we investigated both, the consequence of a low-sodium diet on urinary volume and calcium excretion, and the influence of a low-sodium low-calcium diet on urinary oxalate excretion.

RESULTS

Of the 169 patients with CaOx stones, 49 presented with hypercalciuria at baseline. The diet resulted in a highly significant reduction in 24-h urinary sodium and calcium excretion: from 201 ± 89 at baseline to 128 ± 88 mmol/d for sodium (p < 0.0001), and from 5.67 ± 3.01 to 4.06 ± 2.46 mmol/d (p < 0.0001) for calcium, respectively. Urine volume remained unchanged. Notably, no increase in oxalate excretion occurred on the restricted diet (0.39 ± 0.26 vs 0.39 ± 0.19 mmol/d, p = 0.277). Calculated Psf (probability of stone formation) values were only predictive for the risk of calcium phosphate stones.

CONCLUSION

A diet low in sodium and calcium in recurrent calcium oxalate stone formers resulted in a significant reduction of urinary calcium excretion, but no change in urine volume. In this population with apparently low intake of dairy products, calcium restriction does not necessarily result in increased urinary oxalate excretion. However, based on previous studies, we recommend a normal dietary calcium intake to avoid a potential increase in urinary oxalate excretion and unfavorable effects on bone metabolism in hypercalciuric KSFs.

Authors+Show Affiliations

Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.Division of Nephrology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy.Department of Urology, University Hospital Zurich, Zurich, Switzerland.Centre for Nephrology, University College London, London, UK.Division of Nephrology, Stadtspital Waid, Zurich, Switzerland.Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.Centre for Nephrology, University College London, London, UK.Institute of Physiology, University of Zurich, Zurich, Switzerland. , National Center for Competence in Research NCCR Kidney, CH, Zurich, Switzerland.Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland. nilufar.mohebbi@usz.ch.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29202723

Citation

Seeger, Harald, et al. "Changes in Urinary Risk Profile After Short-term Low Sodium and Low Calcium Diet in Recurrent Swiss Kidney Stone Formers." BMC Nephrology, vol. 18, no. 1, 2017, p. 349.
Seeger H, Kaelin A, Ferraro PM, et al. Changes in urinary risk profile after short-term low sodium and low calcium diet in recurrent Swiss kidney stone formers. BMC Nephrol. 2017;18(1):349.
Seeger, H., Kaelin, A., Ferraro, P. M., Weber, D., Jaeger, P., Ambuehl, P., ... Mohebbi, N. (2017). Changes in urinary risk profile after short-term low sodium and low calcium diet in recurrent Swiss kidney stone formers. BMC Nephrology, 18(1), p. 349. doi:10.1186/s12882-017-0755-7.
Seeger H, et al. Changes in Urinary Risk Profile After Short-term Low Sodium and Low Calcium Diet in Recurrent Swiss Kidney Stone Formers. BMC Nephrol. 2017 Dec 4;18(1):349. PubMed PMID: 29202723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in urinary risk profile after short-term low sodium and low calcium diet in recurrent Swiss kidney stone formers. AU - Seeger,Harald, AU - Kaelin,Andrea, AU - Ferraro,Pietro M, AU - Weber,Damian, AU - Jaeger,Philippe, AU - Ambuehl,Patrice, AU - Robertson,William G, AU - Unwin,Robert, AU - Wagner,Carsten A, AU - Mohebbi,Nilufar, Y1 - 2017/12/04/ PY - 2017/06/30/received PY - 2017/11/14/accepted PY - 2017/12/6/entrez PY - 2017/12/6/pubmed PY - 2018/7/19/medline KW - Calcium oxalate KW - Diet KW - Hypercalciuria KW - Nephrolithiasis KW - Urolithiasis SP - 349 EP - 349 JF - BMC nephrology JO - BMC Nephrol VL - 18 IS - 1 N2 - BACKGROUND: Kidney stone disease is common in industrialized countries. Recently, it has attracted growing attention, because of its significant association with adverse renal outcomes, including end stage renal disease. Calcium-containing kidney stones are frequent with high recurrence rates. While hypercalciuria is a well-known risk factor, restricted intake of animal protein and sodium, combined with normal dietary calcium, has been shown to be more effective in stone prevention compared with a low-calcium diet. Notably, the average sodium intake in Switzerland is twice as high as the WHO recommendation, while the intake of milk and dairy products is low. METHODS: We retrospectively analyzed Swiss recurrent kidney stone formers (rKSF) to test the impact of a low-sodium in combination with a low-calcium diet on the urinary risk profile. In patients with recurrent calcium oxalate containing stones, we investigated both, the consequence of a low-sodium diet on urinary volume and calcium excretion, and the influence of a low-sodium low-calcium diet on urinary oxalate excretion. RESULTS: Of the 169 patients with CaOx stones, 49 presented with hypercalciuria at baseline. The diet resulted in a highly significant reduction in 24-h urinary sodium and calcium excretion: from 201 ± 89 at baseline to 128 ± 88 mmol/d for sodium (p < 0.0001), and from 5.67 ± 3.01 to 4.06 ± 2.46 mmol/d (p < 0.0001) for calcium, respectively. Urine volume remained unchanged. Notably, no increase in oxalate excretion occurred on the restricted diet (0.39 ± 0.26 vs 0.39 ± 0.19 mmol/d, p = 0.277). Calculated Psf (probability of stone formation) values were only predictive for the risk of calcium phosphate stones. CONCLUSION: A diet low in sodium and calcium in recurrent calcium oxalate stone formers resulted in a significant reduction of urinary calcium excretion, but no change in urine volume. In this population with apparently low intake of dairy products, calcium restriction does not necessarily result in increased urinary oxalate excretion. However, based on previous studies, we recommend a normal dietary calcium intake to avoid a potential increase in urinary oxalate excretion and unfavorable effects on bone metabolism in hypercalciuric KSFs. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/29202723/Changes_in_urinary_risk_profile_after_short_term_low_sodium_and_low_calcium_diet_in_recurrent_Swiss_kidney_stone_formers_ L2 - https://www.biomedcentral.com/1471-2369/18/349 DB - PRIME DP - Unbound Medicine ER -