Changes in urinary risk profile after short-term low sodium and low calcium diet in recurrent Swiss kidney stone formers

BMC Nephrology

Research Article

Philippe Jaeger¹  Robert Unwin¹  Damian Weber²  Pietro M. Ferraro³  Patrice Ambuehl⁴  Nilufar Mohebbi⁵  Andrea Kaelin⁵  Harald Seeger⁵  Carsten A. Wagner⁶  William G. Robertson⁷ 

[1] Centre for Nephrology, University College London, London, UK;Department of Urology, University Hospital Zurich, Zurich, Switzerland;Division of Nephrology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy;Division of Nephrology, Stadtspital Waid, Zurich, Switzerland;Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland;Institute of Physiology, University of Zurich, Zurich, Switzerland;National Center for Competence in Research NCCR Kidney, CH, Zurich, Switzerland;Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK;

关键词: Nephrolithiasis;    Urolithiasis;    Hypercalciuria;    Calcium oxalate;    Diet;   

DOI  :  10.1186/s12882-017-0755-7

 received in 2017-06-30, accepted in 2017-11-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundKidney stone disease is common in industrialized countries. Recently, it has attracted growing attention, because of its significant association with adverse renal outcomes, including end stage renal disease. Calcium-containing kidney stones are frequent with high recurrence rates. While hypercalciuria is a well-known risk factor, restricted intake of animal protein and sodium, combined with normal dietary calcium, has been shown to be more effective in stone prevention compared with a low-calcium diet. Notably, the average sodium intake in Switzerland is twice as high as the WHO recommendation, while the intake of milk and dairy products is low.MethodsWe retrospectively analyzed Swiss recurrent kidney stone formers (rKSF) to test the impact of a low-sodium in combination with a low-calcium diet on the urinary risk profile. In patients with recurrent calcium oxalate containing stones, we investigated both, the consequence of a low-sodium diet on urinary volume and calcium excretion, and the influence of a low-sodium low-calcium diet on urinary oxalate excretion.ResultsOf the 169 patients with CaOx stones, 49 presented with hypercalciuria at baseline. The diet resulted in a highly significant reduction in 24-h urinary sodium and calcium excretion: from 201 ± 89 at baseline to 128 ± 88 mmol/d for sodium (p < 0.0001), and from 5.67 ± 3.01 to 4.06 ± 2.46 mmol/d (p < 0.0001) for calcium, respectively. Urine volume remained unchanged. Notably, no increase in oxalate excretion occurred on the restricted diet (0.39 ± 0.26 vs 0.39 ± 0.19 mmol/d, p = 0.277). Calculated Psf (probability of stone formation) values were only predictive for the risk of calcium phosphate stones.ConclusionA diet low in sodium and calcium in recurrent calcium oxalate stone formers resulted in a significant reduction of urinary calcium excretion, but no change in urine volume. In this population with apparently low intake of dairy products, calcium restriction does not necessarily result in increased urinary oxalate excretion. However, based on previous studies, we recommend a normal dietary calcium intake to avoid a potential increase in urinary oxalate excretion and unfavorable effects on bone metabolism in hypercalciuric KSFs.

【 授权许可】

CC BY   
© The Author(s). 2017