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The effects of drinking bicarbonate-rich mineral water in calcium oxalate stone formers: an open label prospective randomized controlled study in an Asian cohort

  • Urology - Original Paper
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Abstract

Purpose

To examine the effects of drinking bicarbonate-rich mineral water in patients with calcium oxalate stones.

Materials and methods

This was an open label prospective randomized controlled study comparing the effects of a bicarbonate-rich mineral water versus plain water on urine biochemistry in patients with calcium oxalate stones. The mineral water group were instructed to consume 1.25 L of mineral water per day at meal times, and supplemented by plain water. Their total intake was up to 3 L/day. Control group consumed only plain water up to 3 L/day. 24 h urine analyses were performed at baseline, 1, 4, 8 and 12 weeks after starting protocol.

Results

58 patients were recruited for the study. 51 patients were included in the final analysis. Baseline data were comparable between the two groups. Over the course of 12 weeks, compared to patients drinking plain water, those drinking mineral water had higher overall urinary volume (difference = 644.0 ml/24 h, 95% CI = (206.7, 1081.3)), higher overall urinary magnesium (difference = 1.894 mmol/24 h, 95% CI = (1.006, 2.782)), and pH (difference = 0.477, 95% CI = (0.149, 0.804)). However, there was no difference in urinary oxalate and Tiselius index. Mineral water group had net increase of urinary citrate (at each study point compared to baseline) which was sustained until week 12, whereas plain water group showed no significant change.

Conclusions

Drinking bicarbonate-rich mineral water in calcium oxalate stone formers increased stone inhibitors such as magnesium, citrate and moderate degree of urinary alkalinization compared to patients drinking plain water, but it did not alter Tiselius index or urinary oxalate after 12 weeks.

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Funding

The authors thank Halden United Investment Pte Ltd (Singapore) for sponsoring this study with a research grant. The authors thank Dr. Natalia Liem for her contribution in project conceptualization. Dr Natalia Liem was a shareholder of Halden Investment Group at the time but she had recused herself entirely from the study in terms of trial design, planning, randomization, execution, data collection/analysis and manuscript writing/revision. Her role was solely in the initial project conceptualization. All listed authors have no relevant financial or non-financial interests to disclose. The authors thank project manager Ms Joanne Tan San Mui and research coordinators Mr. Pee Chor Chia and Mr. Liong Tuck Chee for their dedicated work and contribution.

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Authors and Affiliations

  1. Department of Urology, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore

    Yadong Lu, Palaniappan Sundaram & Tsung Wen Chong

  2. Health Services Research Unit, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore

    HuiHua Li

Authors
  1. Yadong Lu
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  2. Palaniappan Sundaram
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  4. Tsung Wen Chong
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Contributions

YL: conception and design, data acquisition, data analysis and interpretation, drafting the manuscript, critical revision of the manuscript for scientific and factual content, statistical analysis; PS: conception and design, data acquisition, critical revision of the manuscript for scientific and factual content; HL: conception and design, data analysis and interpretation, statistical analysis; TWC: conception and design, data analysis and interpretation, critical revision of the manuscript for scientific and factual content, supervision.

Corresponding author

Correspondence to Yadong Lu.

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Conflict of interest

The authors have nothing to disclose.

Human and animal rights

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of SingHealth (CIRB Ref 2016/3161). The study was registered with ClinicalTrials.gov (Trial number NCT04638166).

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Informed consent was obtained from all individual participants included in the study.

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Lu, Y., Sundaram, P., Li, H. et al. The effects of drinking bicarbonate-rich mineral water in calcium oxalate stone formers: an open label prospective randomized controlled study in an Asian cohort. Int Urol Nephrol 54, 2133–2140 (2022). https://doi.org/10.1007/s11255-022-03256-8

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  • DOI: https://doi.org/10.1007/s11255-022-03256-8

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