Advertisement

Twenty-four-hour urine osmolality as a representative index of adequate hydration and a predictor of recurrence in patients with urolithiasis

  • Ho Won Kang
  • Sung Pil Seo
  • Yun-Sok Ha
  • Won Tae Kim
  • Yong-June Kim
  • Seok-Joong Yun
  • Wun-Jae Kim
  • Sang-Cheol LeeEmail author
Urology - Original Paper
  • 29 Downloads

Abstract

Purpose

To determine the value of 24-h urine osmolality (UOsm) as a representative index of adequate hydration and predictor of stone recurrence in patients with urolithiasis.

Methods

Medical records of consecutive patients presenting with renal or ureteric stones between 1994 and 2017 were retrospectively reviewed. Patients were grouped according to the results of 24-h UOsm (low ≤ 564 mOsm/kg H2O, high > 564 mOsm/kg H2O). Metabolic parameters and risk of stone recurrence were compared between the two groups.

Results

The low urine concentration group were more likely to be older, to be female, and to have a lower body mass index and higher glomerular filtration rate than the high concentration group (each P < 0.005). A positive correlation was seen between 24-h UOsm and urinary calcium, sodium, uric acid, and magnesium excretion and 24-h specific gravity; a negative correlation was seen with 24-h urine volume. Stone-forming constituents, such as calcium and uric acid, were significantly higher in the high urine concentration group. Kaplan–Meier estimates showed that the low urine concentration group had a significantly longer stone recurrence-free period than the high urine concentration group (log-rank test, P < 0.001). In multivariate Cox regression analyses, 24-h UOsm was seen to be an independent risk factor for stone recurrence.

Conclusions

UOsm is a promising approach to assessing hydration and predicting stone recurrence in patients with urolithiasis. Maintaining UOsm < 564 mOsm/kg H2O may reduce the risk of stone recurrence.

Keywords

Urinary calculi Osmolar concentration Recurrence 

Notes

Funding

The research was supported by the International Science and Business Belt Program through the Ministry of Science, ICT and Future Planning (2015-DD-RD-0070).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The requirement for informed consent was waived due to the retrospective nature of the study.

Supplementary material

11255_2019_2108_MOESM1_ESM.tif (6 mb)
Supplementary Figure Receiver operating characteristic curve of 24 h urine osmolality for the prediction of stone recurrence (Area under the receiver operating characteristic curve = 0.595; 95% confidence interval, 0.56–0.63; P = 0.002) (TIF 6174 KB)

References

  1. 1.
    Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TM (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316–324Google Scholar
  2. 2.
    Liu Y, Chen Y, Liao B, Luo D, Wang K, Li H, Zeng G (2018) Epidemiology of urolithiasis in Asia. Asian J Urol 5(4):205–214Google Scholar
  3. 3.
    Kang HW, Seo SP, Ha Y-S, Kim WT, Kim Y-J, Yun SJ, Kim W-J, Lee S-C (2017) Chronological trends in clinical and urinary metabolic features over 20 years in Korean urolithiasis patients. J Korean Med Sci 32(9):1496–1501Google Scholar
  4. 4.
    Siener R, Laube N, Strohmaier W (2011) Recurrence prevention of urolithiasis with respect to economic aspects. Urologe A 50(10):1276, 1278–1282Google Scholar
  5. 5.
    Tiselius H-G, Daudon M, Thomas K, Seitz C (2017) Metabolic work-up of patients with urolithiasis: indications and diagnostic algorithm. Eur Urol Focus 3(1):62–71Google Scholar
  6. 6.
    Lotan Y (2009) Economics and cost of care of stone disease. Adv Chronic Kidney Dis 16(1):5–10Google Scholar
  7. 7.
    Skolarikos A, Straub M, Knoll T, Sarica K, Seitz C, Petřík A, Türk C (2015) Metabolic evaluation and recurrence prevention for urinary stone patients: EAU guidelines. Eur Urol 67(4):750–763Google Scholar
  8. 8.
    Fisang C, Anding R, Müller SC, Latz S, Laube N (2015) Urolithiasis—an interdisciplinary diagnostic, therapeutic and secondary preventive challenge. Deutsch Arztebl Int 112(6):83Google Scholar
  9. 9.
    Jung H, Andonian S, Assimos D, Averch T, Geavlete P, Kohjimoto Y, Neisius A, Philip J, Saita A, Shah H (2017) Urolithiasis: evaluation, dietary factors, and medical management: an update of the 2014 SIU-ICUD international consultation on stone disease. World J Urol 35(9):1331–1340Google Scholar
  10. 10.
    Siener R, Schade N, Nicolay C, von Unruh GE, Hesse A (2005) The efficacy of dietary intervention on urinary risk factors for stone formation in recurrent calcium oxalate stone patients. J Urol 173(5):1601–1605Google Scholar
  11. 11.
    Curhan GC, Goldfarb S, Post TW (2016) Prevention of recurrent calcium stones in adults. https://www.uptodate.com/contents/prevention-of-recurrent-calcium-stones-in-adults
  12. 12.
    Prezioso D, Strazzullo P, Lotti T, Bianchi G, Borghi L, Caione P, Carini M, Caudarella R, Gambaro G, Gelosa M (2015) Dietary treatment of urinary risk factors for renal stone formation: a review of CLU working group. Arch Ital Urol Androl 87(2):105–120Google Scholar
  13. 13.
    Ticinesi A, Nouvenne A, Borghi L, Meschi T (2017) Water and other fluids in nephrolithiasis: state of the art and future challenges. Crit Rev Food Sci Nutr 57(5):963–974Google Scholar
  14. 14.
    Mitra P, Pal DK, Das M (2018) Does quality of drinking water matter in kidney stone disease: a study in West Bengal, India. Investig Clin Urol 59(3):158–165Google Scholar
  15. 15.
    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(3):839–843Google Scholar
  16. 16.
    Lotan Y, Daudon M, Bruyère F, Talaska G, Strippoli G, Johnson RJ, Tack I (2013) Impact of fluid intake in the prevention of urinary system diseases: a brief review. Curr Opin Nephrol Hypertens 22:S1–S10Google Scholar
  17. 17.
    Siener R, Hesse A (2003) Fluid intake and epidemiology of urolithiasis. Eur J Clin Nutr 57(S2):S47Google Scholar
  18. 18.
    Lotan Y, Jiménez IB, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten M (2013) Increased water intake as a prevention strategy for recurrent urolithiasis: major impact of compliance on cost-effectiveness. J Urol 189(3):935–939Google Scholar
  19. 19.
    Cockcroft DW, Gault H (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16(1):31–41Google Scholar
  20. 20.
    Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2015) Guidelines on urolithiasis. Eur Urol 40:362–371Google Scholar
  21. 21.
    Khorami MH, Hashemi R, Bagherian-Sararoudi R, Sichani MM, Tadayon F, Shahdoost AA, Arezegar SH (2012) The assessment of 24 24-h urine volume by measurement of urine specific gravity with dipstick in adults with nephrolithiasis. Adv Biomed Res.  https://doi.org/10.4103/2277-9175.105168 Google Scholar
  22. 22.
    Perrier E, Rondeau P, Poupin M, Le Bellego L, Armstrong L, Lang F, Stookey J, Tack I, Vergne S, Klein A (2013) Relation between urinary hydration biomarkers and total fluid intake in healthy adults. Eur J Clin Nutr 67(9):939Google Scholar
  23. 23.
    Perrier E, Vergne S, Klein A, Poupin M, Rondeau P, Le Bellego L, Armstrong LE, Lang F, Stookey J, Tack I (2013) Hydration biomarkers in free-living adults with different levels of habitual fluid consumption. Br J Nutr 109(9):1678–1687Google Scholar
  24. 24.
    Armstrong LE (2007) Assessing hydration status: the elusive gold standard. J Am Coll Nutr 26(Suppl 5):575S–584SGoogle Scholar
  25. 25.
    Perrier ET, Buendia-Jimenez I, Vecchio M, Armstrong LE, Tack I, Klein A (2015) Twenty-four-hour urine osmolality as a physiological index of adequate water intake. Dis Markers 2015:231063Google Scholar
  26. 26.
    Cadoff RE, Drach GW, LeBouton J (1988) Specific gravity test strips used in monitoring urine concentrations of urolithiasis patients. J Urol 139(2):323–325Google Scholar
  27. 27.
    Türk C, Neisius A, Petrik C, Seitz C, Skolarikos A, Tapeler K, Thomas K (2017) EAU urolithiasis guidelines. http://uroweb.org/guideline/urolithiasis/
  28. 28.
    Voinescu GC, Shoemaker M, Moore H, Khanna R, Nolph KD (2002) The relationship between urine osmolality and specific gravity. Am J Med Sci 323(1):39–42Google Scholar
  29. 29.
    Chadha V, Garg U, Alon US (2001) Measurement of urinary concentration: a critical appraisal of methodologies. Pediatr Nephrol 16(4):374–382Google Scholar
  30. 30.
    Manz F, Wentz A (2003) 24-h hydration status: parameters, epidemiology and recommendations. Eur J Clin Nutr 57(S2):S10Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Urology, College of Medicine and Institute for Tumor ResearchChungbuk National UniversityCheonjuKorea
  2. 2.Department of UrologyChungbuk National University HospitalCheongjuKorea
  3. 3.Department of Urology, School of MedicineKyungpook National UniversityDaeguKorea

Personalised recommendations