Journal of Nephrology

, Volume 29, Issue 2, pp 211–219 | Cite as

Treatment effect, adherence, and safety of high fluid intake for the prevention of incident and recurrent kidney stones: a systematic review and meta-analysis

  • Wisit Cheungpasitporn
  • Sandro Rossetti
  • Keith Friend
  • Stephen B. Erickson
  • John C. LieskeEmail author
Original Article



The objective of this systematic review and meta-analysis were to evaluate the effectiveness of high fluid intake for the prevention of incident and recurrent kidney stones, as well as its adherence and safety.


A literature search was performed encompassing 1980 through July 2014. Studies that reported relative risks, odds ratios, or hazard ratios comparing the risk of kidney stone events in patients with high vs inadequate fluid intake were included. Pooled risk ratios (RRs) and 95 % confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.


Nine studies [2 randomized controlled trials (RCTs) with 269 patients; 7 observational studies with 273,685 individuals] were included in the meta-analysis. Pooled RRs of kidney stones in individuals with high-fluid intake were 0.40 (95 % CI 0.20–0.79) and 0.49 (0.34–0.71) in RCTs and observational studies, respectively. High fluid intake was significantly associated with reduced risk of recurrent kidney stones: RRs 0.40 (95 % CI 0.20–0.79) and 0.20 (0.09–0.44) in RCTs and observational studies, respectively. Adherence and safety data on high fluid intake treatment were limited; 1 RCT reported no withdrawals due to adverse events.


This analysis demonstrated a significantly reduced risk of incident kidney stones among individuals with high fluid consumption. High fluid consumption also reduced the risk of recurrent kidney stones. Furthermore, the magnitude of risk reduction was high. Although increased water intake appears to be safe, future studies on its safety in patients with high risk of volume overload or hyponatremia may be indicated.


Meta-analysis Fluid intake Kidney stones Water Hyponatremia 



American Urological Association


American College of Physicians


Confidence interval


Randomized clinical trial


Risk ratio



Research work for this review was supported by Otsuka America Pharmaceutical, Inc. Editorial assistance was provided by Catherine Fontana and Geoff Marx of BioScience Communications (New York, NY), which was funded by Otsuka. The investigators also acknowledge support from the Rare Kidney Stone Consortium (U54KD083908), a member of the NIH Rare Diseases Clinical Research Network (RDCRN), funded by the NIDDK and the National Center for Advancing Translational Sciences (NCATS), and the Mayo Clinic O’Brien Urology Research Center (U54 DK100227).

Conflict of interest

Wisit Cheungpasitporn, Stephen B. Erickson have nothing to disclose. Sandro Rossetti and Keith Friend are employees of Otsuka America Pharmaceutical, Inc. John C. Lieske Supported by the Mayo Clinic O’Brien Urology Research Center and Rare Kidney Stone Consortium, member of the National Institutes of Health Rare Diseases Clinical Research Network, and funded by the National Institute of Diabetes and Digestive, Kidney Diseases and National Center for Advancing Translational Sciences, and Otsuka America Pharmaceutical, Inc.

Supplementary material

40620_2015_210_MOESM1_ESM.doc (67 kb)
Supplementary material 1 (DOC 67 kb)


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Copyright information

© Italian Society of Nephrology 2015

Authors and Affiliations

  • Wisit Cheungpasitporn
    • 1
  • Sandro Rossetti
    • 2
  • Keith Friend
    • 2
  • Stephen B. Erickson
    • 1
  • John C. Lieske
    • 1
    • 3
    Email author
  1. 1.Division of Nephrology and HypertensionMayo ClinicRochesterUSA
  2. 2.Cardiorenal Department, Medical AffairsOtsuka America Pharmaceutical, Inc.PrincetonUSA
  3. 3.Department of Laboratory Medicine and PathologyMayo ClinicRochesterUSA

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