New Guidelines: Drink up to Prevent Another Kidney Stone

Kidney stones may recur less with higher fluid intake, according to new guidelines

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Kidney stones can cause intense pain and even kidney disease. New guidelines recommend a simple step that might keep kidney stones from coming back.

The Clinical Guidelines Committee of the American College of Physicians (ACP) developed new guidelines to prevent kidney stone recurrence.

The committee recommended drinking extra fluids to keep kidney stones from coming back in people who have already had them. If drinking extra fluids did not work, the committee advised using certain medications.

The guidelines were written by Amir Qaseem, MD, PhD, from the University Health System of Pennsylvania in Philadelphia, and colleagues.

Kidney stones form from crystals and other solid particles in urine and can get stuck in the kidneys and urinary tract.

According to the guidelines, about 13 percent of men and 7 percent of women will get a kidney stone in their lifetime. If not treated, about 35 to 50 percent of people will get another one within five years, according to a 2013 report written by Howard A. Fink, MD, from the Minneapolis Veterans Affairs Medical Center in Minnesota. Dr. Fink's past report was published in Annals of Internal Medicine.

The ACP committee reviewed kidney stone research from 1948 through March 2014 and used the findings to develop the new guidelines. These new guidelines were published Nov. 3 in Annals of Internal Medicine.

The committee found that the risk of getting another kidney stone decreased if people drank more fluids. People who drank enough fluids to make over 2 liters of urine a day had about a 50 percent decreased chance of getting another kidney stone.

People who drank tap water and those who drank mineral water had the same decreased risk, the authors noted.

"Increased fluid intake spread throughout the day can decrease the stone recurrence by at least half with virtually no side effects," said Dr. David A. Fleming, ACP president, in a press release.

E. David Crawford, MD, professor of surgery, urology and radiation oncology at the Anschutz Medical Campus of the University of Colorado in Aurora, told dailyRx News that patients should even pay attention to their fluid intake at night.

"Where many patients fall short is the failure to maintain this increased intake during sleep," Dr. Crawford said. "They should have nocturia (night time urination) and when up drink some more water."

Not all people can drink extra fluids, and drinking extra fluids did not work to prevent another stone in all patients, the authors noted. For instance, drinking extra fluids may not be recommended for some heart failure patients.

When upping fluid intake isn't an option, the guidelines suggest that doctors prescribe certain medications. The medications they suggested were a thiazide diuretic (brand names Lozol and Hydrodiuril) or allopurinol (brand names Zyloprim and Aloprim).

The guidelines said medications containing citrate, such as magnesium citrate or sodium citrate, could also be used to prevent kidney stones. Citrate can prevent calcium stone formation.

The authors noted that the medications had some side effects. These included rashes and stomach and intestinal problems. Only take medications under the direction of a doctor.

The ACP funded the guidelines. Committee members J. Sanford Schwartz, MD, and A. Paul Dallas, MD, owned stock in several pharmaceutical companies and received consulting fees from them.


Review Date: 
October 31, 2014
Last Updated:
November 6, 2014