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Developed by for the Hydration for Health Initiative
Water intake and Kidney stones
Get this content on line
1
http://www.h4hinitiative.com/h4h-academy/hydration-lab/
www.h4hinitiative.com
Epidemiology
Risk factors
Pathophysiology
Focus on chronic dehydration as a major risk factor
High water intake benefits o...
Epidemiology of kidney stones
3
40 to 60% of stone formers will relapse within 5 years following a first episode
Detailed ...
Epidemiology of kidney stones
World map of kidney stones lifetime prevalence in the general population
Lifetime prevalence...
5
Risk factors for kidney stones
A multifactorial disease
Environmental factors
Family history
Ethnicity
Age and Gender
Di...
6
Pathophysiology
A misbalance between urine volume and composition
Low urine
volume
Urine pH
alteration
Promoters
in high...
Chronic dehydration
A major risk factor for kidney stones
Conditions related to chronic dehydration predisposing
to a low ...
High water intake benefits on secondary
prevention of kidney stones
Increasing water intake to reduce the risk of kidney s...
A
1406 subjects
High water intake benefits on primary
prevention of kidney stones
To date, only one remote study from 1966...
Hypothetical estimation model of cost savings by French Health care system
through stones prevention by increased water in...
General measures for the prevention of kidney
stones recurrence
Based on the EAU guidelines for nephrolithiasis patients
I...
EFSA Recommendations
for Total Water Intake (TWI) in Europe
1-2
years
2-3
years
4-8
years
9-13
years
14-18
years
Adults
Pr...
Key facts to keep in mind
Recommendation
for total water
intake
EFSA
14-18
years
Adults
Women 2L/d
Men 2,5L/d
Prevalence 1...
Access Kidney stones Monograph online
To learn more
14
Visit the kidney facts website
http://www.h4hinitiative.com/h4h-
ac...
Shah J, Whitfield HN. (2002) Urolithiasis through the ages. BJU.Int. 89:801-810.
Ettinger B. (1979) Recurrence of nephroli...
Bibliographic references
16
Slide 5 – Risk factor of kidney stones (1/2)
Brenner B and Rector JRF. (2008) Nephrolithiasis....
Bibliographic references
17
Slide 5 – Risk factor of kidney stones (2/2)
Bartoletti R, Cai T, Mondaini N, Melone F, Travag...
Bibliographic references
18
Slide 6 – Pathophysiology
Curhan GC, Willett WC, Rimm EB, Stampfer MJ. (1993) A prospective st...
Bibliographic references
19
Slide 7 – Chronic dehydration (1/2)
Brenner B and Rector JRF. (2008) Nephrolithiasis. In: Bren...
Borghi L, Meschi T, Schianchi T, Briganti A, Guerra A, Allegri F, Novarini A. (1999c) Urine volume: stone risk factor and ...
Frank M, De VA. (1966) Prevention of urolithiasis. Education to adequate fluid intake in a new town situated in the Judean...
Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M. (2001) Guidelines on urolithiasis. Eur Urol. 40:362-371.
...
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Water intake and Kidney Stones

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A summary of the epidemiology and pathophysiology of kidney stones, and scientific review on water intake for the prevention and reduction of health costs in stone disease.

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Water intake and Kidney Stones

  1. 1. Developed by for the Hydration for Health Initiative Water intake and Kidney stones
  2. 2. Get this content on line 1 http://www.h4hinitiative.com/h4h-academy/hydration-lab/ www.h4hinitiative.com
  3. 3. Epidemiology Risk factors Pathophysiology Focus on chronic dehydration as a major risk factor High water intake benefits on secondary prevention of kidney stones High water intake benefits on primary prevention of kidney stones Hypothetical impact of adequate water intake on health costs General measures for the prevention of kidney stones recurrence EFSA recommendations for total water intake Key facts References– References are sorted by slide, at the end of the presentation Content 2 www.h4hinitiative.com
  4. 4. Epidemiology of kidney stones 3 40 to 60% of stone formers will relapse within 5 years following a first episode Detailed on next page = €590 million (year 2011) > $2.1 billion (year 2000) Prevalence: 10% worldwide and increasing Kidney stones are also called lithiasis or urolithiasis, while nephrolithiasis refers more precisely to stones located in the kidney. www.h4hinitiative.com Urolithiasis is more prevalent among men than among women Health costs are considerable More common in adults aged 30 to 50 years old Increasing trend in children
  5. 5. Epidemiology of kidney stones World map of kidney stones lifetime prevalence in the general population Lifetime prevalence in men Mean lifetime prevalenceLifetime prevalence in women 4 www.h4hinitiative.com
  6. 6. 5 Risk factors for kidney stones A multifactorial disease Environmental factors Family history Ethnicity Age and Gender Diet Dehydration Overweight, obesity, diabetes, hypertension Lifestyle related factors Occupation Intense physical activity Geography Climate & Temperature Individual factors Non modifiable factors www.h4hinitiative.com
  7. 7. 6 Pathophysiology A misbalance between urine volume and composition Low urine volume Urine pH alteration Promoters in high concentration Inhibitors in low concentration Urinary risk factors of lithogenesis Lithogenesis About 60 to 80% of stones are composed of calcium oxalate Individual & environmental risk factors www.h4hinitiative.com
  8. 8. Chronic dehydration A major risk factor for kidney stones Conditions related to chronic dehydration predisposing to a low urine volume 7 Higher urinary compounds concentration Low urine volume Work in hot environment Intense physical activity High sunlight exposure Hot climate Low fluid intake Uncompensated water losses risk of kidney stones7,10,33 www.h4hinitiative.com
  9. 9. High water intake benefits on secondary prevention of kidney stones Increasing water intake to reduce the risk of kidney stones recurrence: Borghi et al, 1996 12,1% 27% 5-year follow-up 5-year follow-up Recruitment of 300 stone formers after 1st episode Increased fluid intake is an effective preventive measure for kidney stones recurrence. 8 www.h4hinitiative.com A 199 subjects B 101 subjects Total urine: 2,0L/day Intervention: ↗ water intake No instruction on fluid intake
  10. 10. A 1406 subjects High water intake benefits on primary prevention of kidney stones To date, only one remote study from 1966 suggests that increasing water intake could help reduce the incidence of kidney stones: Frank et al, 1966 0,28% 0,85% 3-year follow-up 3-year follow-up Stone prevalence 5385 subjects with no history of kidney stones, from 2 towns in arid desert Stronger evidence is needed to assess the role of increased water intake on prevention of first episodes of kidney stones. 9 Urine volume B 3979 subjects www.h4hinitiative.com Intervention: Education to increase fluid intake No instruction on fluid intake
  11. 11. Hypothetical estimation model of cost savings by French Health care system through stones prevention by increased water intake. Recurrence prevention First time prevention % of compliance to adequate water intake of 2L 100% 25% 100% 25% Number of stones prevented 11,572 2,893 9,625 2,316 Cost savings in million € 49 10 273 68 Prevention of first stones and stones recurrence, with an adequate water intake of 2.0L per day could be cost-effective and could reduce the economic burden of urolithiasis. www.h4hinitiative.com 10 Cost savings were calculated with a Markov statistical model for an adequate water intake of 2.0L/d Hypothetical impact of adequate water intake on health costs of kidney stones
  12. 12. General measures for the prevention of kidney stones recurrence Based on the EAU guidelines for nephrolithiasis patients Increased fluid intake Urine volume > 2,0L/d Urine Specific Gravity < 1,010 Balanced diet Normal calcium intake (1,000-1,200 mg/d) Limit salt intake (4-5 g/d) Limit animal protein intake (0,8-1 g/kg/d) Lifestyle BMI 18-25 Limit stress Adequate physical activity Balancing excessive fluid loss (adapted from Tiselius et al. 2001) 11 Water is essential and should be at the core of everyone’s daily intake. To prevent recurrence, official guidelines include a fluid intake sufficient to achieve a urine volume of at least 2.0L per day. www.h4hinitiative.com
  13. 13. EFSA Recommendations for Total Water Intake (TWI) in Europe 1-2 years 2-3 years 4-8 years 9-13 years 14-18 years Adults Pregnant women Lactating women Recommended TWI (EFSA 2010) 1,1- 1,2L/d 1,3L/d 1,6L/d Girls 1,9L/d Women 2L/d 2,3L/d 2,7L/d Boys 2,1L/d Men 2,5L/d 12 EFSA recommendations for TWI for adults: Are in line with EAU guidelines to prevent kidney stones recurrence If followed, could help reduce the economic burden of urolithiasis www.h4hinitiative.com
  14. 14. Key facts to keep in mind Recommendation for total water intake EFSA 14-18 years Adults Women 2L/d Men 2,5L/d Prevalence 10% Guidelines to prevent recurrence > 2L/ dayUrine volume 13 Low urine volume Risk of kidney stones Chronic dehydration Urine Supersaturation Costs are considerable$ Adequate water intake is: cost-effective can help reduce the economic burden of kidney stones. 2L Fluid intake Kidney stones recurrence www.h4hinitiative.com
  15. 15. Access Kidney stones Monograph online To learn more 14 Visit the kidney facts website http://www.h4hinitiative.com/h4h- academy/hydration-lab/ More information on kidney and kidney stones http://www.kidney-facts.com Visit the H4H website www.h4hinitiative.com
  16. 16. Shah J, Whitfield HN. (2002) Urolithiasis through the ages. BJU.Int. 89:801-810. Ettinger B. (1979) Recurrence of nephrolithiasis. A six-year prospective study. Am J Med 67:245-248. Hosking DH, Erickson SB, Van den Berg CJ, Wilson DM, Smith LH. (1983) The stone clinic effect in patients with idiopathic calcium urolithiasis. J Urol. 130:1115-1118. Sutherland JW, Parks JH, Coe FL. (1985) Recurrence after a single renal stone in a community practice. Miner.Electrolyte. Metab 11:267-269. Brenner B and Rector JRF. (2008) Nephrolithiasis. In: Brenner and Rector’s: The Kidney. Philadelphia (PA): Saunders, 1299- 1349. Ramello A, Vitale C, Marangella M. (2000) Epidemiology of nephrolithiasis. J Nephrol. 13 Suppl 3:S45-S50. Trinchieri A, Cappoli S, Esposito N, Acquati P. (2008) Epidemiology of renal colic in a district general hospital. Arch.Ital.Urol. Androl. 80:1-4. Ferrari P, Piazza R, Ghidini N, Bisi M, Galizia G, Ferrari G. (2007) Lithiasis and risk factors. Urol.Int. 79 Suppl 1:8-15. Sas DJ. (2011) An update on the changing epidemiology and metabolic risk factors in pediatric kidney stone disease Clin.J Am.Soc.Nephrol. 6:2062-2068. Clayton DB, Pope JC. (2011) The increasing pediatric stone disease problem. Ther.Adv.Urol. 3:3-12. Lopez M, Hoppe B. (2010) History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol. 25:49-59. Lotan Y, Buendia J, I, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ. (2012) Primary prevention of nephrolithiasis is cost-effective for a national healthcare system. BJU.Int. 110:E1060-E1067. Pearle MS, Calhoun EA, Curhan GC. (2005) Urologic diseases in America project: urolithiasis. J Urol. 173:848-857. Bibliographic references 15 Slide 3 – Epidemiology of kidney stones
  17. 17. Bibliographic references 16 Slide 5 – Risk factor of kidney stones (1/2) Brenner B and Rector JRF. (2008) Nephrolithiasis. In: Brenner and Rector’s: The Kidney. Philadelphia (PA): Saunders, 1299-1349. Ramello A, Vitale C, Marangella M. (2000) Epidemiology of nephrolithiasis. J Nephrol. 13 Suppl 3:S45-S50. Trinchieri A, Cappoli S, Esposito N, Acquati P. (2008) Epidemiology of renal colic in a district general hospital. Arch.Ital.Urol. Androl. 80:1-4. Ferrari P, Piazza R, Ghidini N, Bisi M, Galizia G, Ferrari G. (2007) Lithiasis and risk factors. Urol.Int. 79 Suppl 1:8-15. Coe FL, Parks JH, Moore ES. (1979) Familial idiopathic hypercalciuria. N Engl J Med 300:337-340. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. (1997a) Family history and risk of kidney stones. J Am Soc.Nephrol. 8:1568-1573. Serio A, Fraioli A. (1999) Epidemiology of nephrolithiasis. Nephron. 81 Suppl 1:26-30. Soucie JM, Thun MJ, Coates RJ, McClellan W, Austin H. (1994) Demographic and geographic variability of kidney stones in the United States. Kidney.Int. 46:893-899. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. (2003) Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney.Int. 63:1817-1823. Scales CD, Jr., Smith AC, Hanley JM, Saigal CS. (2012) Prevalence of kidney stones in the United States. Eur.Urol. 62:160-165. Borghi L, Meschi T, Schianchi T, Briganti A, Guerra A, Allegri F, Novarini A. (1999c) Urine volume: stone risk factor and preventive measure. Nephron. 81 Suppl 1:31-37. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. (1993) A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 328:833-838. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. (1997b) Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann.Intern.Med 126:497-504.
  18. 18. Bibliographic references 17 Slide 5 – Risk factor of kidney stones (2/2) Bartoletti R, Cai T, Mondaini N, Melone F, Travaglini F, Carini M, Rizzo M. (2007) Epidemiology and risk factors in urolithiasis. Urol.Int. 79 Suppl 1:3-7. Embon OM, Rose GA, Rosenbaum T. (1990) Chronic dehydration stone disease. Br.J Urol. 66:357-362. Brenna I, Dogliotti E, Terranegra A, Raspini B, Soldati L. (2013) Nephrolithiasis: nutrition as cause or therapeutic tool. J Transl.Med 11:178. Daudon M, Traxer O, Jungers P. (2012). Lithiase Urinaire. Paris: Lavoisier. Borghi L, Meschi T, Guerra A, Briganti A, Schianchi T, Allegri F, Novarini A. (1999b) Essential arterial hypertension and stone disease. Kidney.Int. 55:2397-2406. Atan L, Andreoni C, Ortiz V, Silva EK, Pitta R, Atan F, Srougi M. (2005) High kidney stone risk in men working in steel industry at hot temperatures. Urology. 65:858-861. Irving RA, Noakes TD, Rodgers AL, Swartz L. (1986) Crystalluria in marathon runners. 1. Standard marathon--males. Urol. Res 14:289-294. Milvy P, Colt E, Thornton J. (1981) A high incidence of urolithiasis in male marathon runners. J Sports Med Phys.Fitness 21:295-298. Frank M, ATSMON A, SUGAR P, De VA. (1963) Epidemiological investigation of urolithiasis in the hot arid Southern region of Israel. Urol.Int. 15:65-76. Brikowski TH, Lotan Y, Pearle MS. (2008) Climate-related increase in the prevalence of urolithiasis in the United States. Proc.Natl.Acad.Sci.U.S.A. 105:9841-9846. Soucie JM, Coates RJ, McClellan W, Austin H, Thun M. (1996) Relation between geographic variability in kidney stones prevalence and risk factors for stones. Am.J Epidemiol 143:487-495. Chauhan V, Eskin B, Allegra JR, Cochrane DG. (2004) Effect of season, age, and gender on renal colic incidence. Am.J Emerg.Med 22:560- 563.
  19. 19. Bibliographic references 18 Slide 6 – Pathophysiology Curhan GC, Willett WC, Rimm EB, Stampfer MJ. (1993) A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 328:833-838. Daudon M, Traxer O, Jungers P. (2012). Lithiase Urinaire. Paris: Lavoisier. Finlayson B. (1978) Physicochemical aspects of urolithiasis. Kidney.Int. 13:344-360. Coe FL, Evan A, Worcester E. (2011) Pathophysiology-based treatment of idiopathic calcium kidney stones. Clin J Am Soc. Nephrol. 6:2083-2092. Curhan GC, Willett WC, Speizer FE, Stampfer MJ. (2001) Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Kidney.Int. 59:2290-2298. Peres LA, Molina AS, Galles MH. (2003) Metabolic investigation of patients with urolithiasis in a specific region. Int.Braz.J Urol. 29:217-220. Elaine M. Worcester, MD & Fredric L. Coe, MD. (2010) Clinical Practice Calcium Kidney Stones. N Engl J Med. 363(10): 954–963. Vadim A. Finkielstein* and David S. Goldfarb†. (2006) Strategies for preventing calcium oxalate stones CMAJ. 174(10): 1407– 1409.
  20. 20. Bibliographic references 19 Slide 7 – Chronic dehydration (1/2) Brenner B and Rector JRF. (2008) Nephrolithiasis. In: Brenner and Rector’s: The Kidney. Philadelphia (PA): Saunders, 1299-1349. Trinchieri A, Cappoli S, Esposito N, Acquati P. (2008) Epidemiology of renal colic in a district general hospital. Arch.Ital.Urol. Androl. 80:1-4. Soucie JM, Thun MJ, Coates RJ, McClellan W, Austin H. (1994) Demographic and geographic variability of kidney stones in the United States. Kidney.Int. 46:893-899. Bartoletti R, Cai T, Mondaini N, Melone F, Travaglini F, Carini M, Rizzo M. (2007) Epidemiology and risk factors in urolithiasis. Urol.Int. 79 Suppl 1:3-7. Embon OM, Rose GA, Rosenbaum T. (1990) Chronic dehydration stone disease. Br.J Urol. 66:357-362. Borghi L, Meschi T, Guerra A, Briganti A, Schianchi T, Allegri F, Novarini A. (1999b) Essential arterial hypertension and stone disease. Kidney.Int. 55:2397-2406. Atan L, Andreoni C, Ortiz V, Silva EK, Pitta R, Atan F, Srougi M. (2005) High kidney stone risk in men working in steel industry at hot temperatures. Urology. 65:858-861. Irving RA, Noakes TD, Rodgers AL, Swartz L. (1986) Crystalluria in marathon runners. 1. Standard marathon--males. Urol. Res 14:289- 294. Frank M, ATSMON A, SUGAR P, De VA. (1963) Epidemiological investigation of urolithiasis in the hot arid Southern region of Israel. Urol.Int. 15:65-76. Brikowski TH, Lotan Y, Pearle MS. (2008) Climate-related increase in the prevalence of urolithiasis in the United States. Proc.Natl.Acad.Sci.U.S.A. 105:9841-9846. Soucie JM, Coates RJ, McClellan W, Austin H, Thun M. (1996) Relation between geographic variability in kidney stones prevalence and risk factors for stones. Am.J Epidemiol 143:487-495.
  21. 21. Borghi L, Meschi T, Schianchi T, Briganti A, Guerra A, Allegri F, Novarini A. (1999c) Urine volume: stone risk factor and preventive measure. Nephron. 81 Suppl 1:31-37. Curhan GC. (2007) Epidemiology of stone disease. Urol.Clin North Am 34:287-293. Curhan GC, Taylor EN. (2008) 24-h uric acid excretion and the risk of kidney stones. Kidney.Int. 73:489-496. Pak CY, Sakhaee K, Crowther C, Brinkley L. (1980) Evidence justifying a high fluid intake in treatment of nephrolithiasis. Ann.Intern.Med 93:36-39. Bibliographic references 20 Slide 7 – Chronic dehydration (2/2) Slide 8 – High water intake benefits on secondary prevention of kidney stones Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. (1996) Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 155:839-843
  22. 22. Frank M, De VA. (1966) Prevention of urolithiasis. Education to adequate fluid intake in a new town situated in the Judean Desert Mountains. Arch.Environ.Health 13:625-630. Bibliographic references 21 Slide 9 - High water intake benefits on primary prevention of kidney stones Slide 10 – Hypothetical impact of adequate water intake on health costs of kidney stones Primary prevention Lotan Y, Buendia J, I, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ. (2012) Primary prevention of nephrolithiasis is cost-effective for a national healthcare system. BJU.Int. 110:E1060-E1067. Secondary prevention Lotan Y, Buendia J, I, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ. (2013) Increased water intake as a prevention strategy for recurrent urolithiasis: major impact of compliance on cost-effectiveness. J Urol. 189:935-939.
  23. 23. Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M. (2001) Guidelines on urolithiasis. Eur Urol. 40:362-371. Bibliographic references 22 Slide 11 - General measures for the prevention of kidney stones recurrence Slide 13 – EFSA Recommendations for Total Water Intake (TWI) in Europe EFSA Panel on Dietetic Products Nutrition and Allergies (NDA). (2010) Scientific Opinion on Dietary Reference Values for water. EFSA Journal. 8(3): 1459-1507.
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