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Voided volume may not impact stone outcomes: Review of a large institutional nephrolithiasis cohort
Kevin Shee1, Carter Chan1, Heiko Yang1
1Department of Urology UCSF San Francisco California USA.
Insights
Increasing fluid intake is recommended for kidney stone prevention. However, this study found that 24-hour voided volume did not significantly impact stone recurrence in most patients, suggesting personalized approaches are needed.
Area of Science:
- Nephrology
- Urology
- Stone Disease Management
Background:
- Urologic guidelines recommend increased fluid intake for kidney stone prevention.
- The efficacy of increased voided volume in reducing stone recurrence and severity is not well-established.
Purpose of the Study:
- To investigate the association between 24-hour voided volume and kidney stone events.
- To explore potential personalized medicine approaches for kidney stone prevention.
Main Methods:
- Retrospective analysis of 450 nephrolithiasis patients from the Registry for Stones of the Kidney and Ureter (ReSKU) (2015-2020).
- Evaluation of kidney stone outcomes (symptomatic passage or surgery) and 24-hour urine data.
- Multivariable logistic regression controlling for age, gender, BMI, and 24-hour sodium and creatinine levels.
Main Results:
- No significant difference in 24-hour voided volume was observed between patients with one stone event versus two or more.
- Multivariable analysis revealed no significant association between voided volume and stone events.
- A negative correlation between voided volume and stone events was found in calcium oxalate dihydrate stone formers only.
Conclusions:
- Twenty-four-hour voided volume was not associated with stone events in a large institutional cohort.
- Subset analysis indicates that increased voided volume may benefit specific stone former types.
- Identifying patients who benefit from increased fluid intake presents a precision medicine opportunity for kidney stone prevention.
Background:
Urologic guidelines universally recommend increasing fluid intake for kidney stone prevention. Increased voided volume is thought to help reduce stone recurrence and severity, but supporting evidence is limited.
Patients And Methods:
Nephrolithiasis outcomes and 24-h urine data for patients from the Registry for Stones of the Kidney and Ureter (ReSKU), a registry of nephrolithiasis patients collected between 2015 and 2020, were retrospectively analysed. Outcome was stone events, either an office visit where a patient reports symptomatic passage of stones or surgery for stone removal.
Results:
We identified 450 stone patients with 24-h urine and kidney stone outcome data. There was no significant difference in 24-h voided volume between patients with one stone event and patients with two or more stone events. On multivariable logistic regression, after controlling for age, gender, BMI, and 24-h sodium and creatinine per kilogram, no significant associations were found between voided volume and stone events. There was a statistically significant negative correlation noted between voided volume and stone events in calcium oxalate dihydrate stone formers (Spearman R = -0.42, p = 0.04), but not others.
Conclusions:
Twenty-four-hour voided volume was not associated with stone events in a large institutional cohort, and subset analysis reveals that some stone formers may benefit more from increased voided volume than others; identifying such patients represents a novel precision medicine opportunity.
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