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What treatments reduce kidney stone risk in patients with bowel disease?

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Abstract

We examined how physicians made therapeutic choices to decrease stone risk in patients with bowel disease without colon resection, many of whom have enteric hyperoxaluria (EH), at a single clinic. We analyzed clinic records and 24-h urine collections before and after the first clinic visit, among 100 stone formers with bowel disease. We used multivariate linear regression and t tests to compare effects of fluid intake, alkali supplementation, and oxalate-focused interventions on urine characteristics. Patients advised to increase fluid intake had lower initial urine volumes (L/day; 1.3 ± 0.5 vs. 1.7 ± 0.7) and increased volume more than those not so advised (0.7 ± 0.6 vs. 0.3 ± 0.6 p = 0.03; intervention vs. non-intervention). Calcium oxalate supersaturation (CaOx SS) fell (95% CI −4.3 to −0.8). Alkali supplementation increased urine pH (0.34 ± 0.53 vs. 0.22 ± 0.55, p = 0.26) and urine citrate (mg/d; 83 ± 256 vs. 98 ± 166, p = 0.74). Patients advised to reduce oxalate (mg/day) absorption had higher urine oxalate at baseline (88 ± 44 vs. 50 ± 26) which was unchanged on follow-up (88 (baseline) vs. 91 (follow-up), p = 0.90). Neither alkali (95% CI −1.4 to 2.1) nor oxalate-focused advice (95% CI −1.2 to 2.3) lowered CaOx SS. Physicians chose treatments based on baseline urine characteristics. Advice to increase fluid intake increased urine volume and decreased CaOx SS. Alkali and oxalate interventions were ineffective.

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Acknowledgements

This study was supported by NIH DK PO1 56788 and NIH 5KL2TR002387.

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  1. Julianna Bianco and Francesca Chu have contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Julianna Bianco, Francesca Chu, Kristin Bergsland, Fredric Coe, Elaine Worcester & Megan Prochaska

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  1. Julianna Bianco
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  2. Francesca Chu
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  3. Kristin Bergsland
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  4. Fredric Coe
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  5. Elaine Worcester
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  6. Megan Prochaska
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Correspondence to Megan Prochaska.

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This study was approved by the University of Chicago Institutional Review Board (Protocol #11943A).

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Bianco, J., Chu, F., Bergsland, K. et al. What treatments reduce kidney stone risk in patients with bowel disease?. Urolithiasis 50, 557–565 (2022). https://doi.org/10.1007/s00240-022-01352-z

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