Effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition: A meta-analysis and systematic review.

Zhenghao Wang,Wuran Wei,Yu Zhang,Tzevat Tefik

doi:10.1371/journal.pone.0250257

Zhenghao Wang, Wuran Wei + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0250257

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Abstract

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) for investigating the effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition. PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases (updated November 2020) were searched for studies with the following keywords: diet, fluid, recurrent, prevention, randomized controlled trials, and nephrolithiasis. The search strategy and study selection process was conducted by following the PRISMA statement. Six RCTs were identified for satisfying the inclusion criteria and enrolled in this meta-analysis. Our result showed that low protein with or without high fiber diet intervention does not decrease the recurrence of stone upon comparing with control groups (RR = 2.32, 95% CI = 0.42-12.85; P = 0.34) with significant heterogeneity among the studies (I2 = 81%, P = 0.02). But normal-calcium, low protein, low-salt diet had recurrences did reduced the recurrence compared to normal-calcium diet. And the fluid intake has a positive effect on prevention of recurrent stone formation (RR = 0.39, 95% CI = 0.19-0.80; P = 0.01) with insignificant heterogeneity among the studies (I2 = 9%, P = 0.30). The different components of urine at baseline were reported in four studies. Upon reviewing the low protein with or without high fiber dietary therapy groups, it was found that there were no obvious changes in the 24-hour urine sodium, calcium, citrate, urea, and sulfate. In conclusion, our study shows that the only low protein with or without fiber does not affect recurrence, but low Na, normal Ca diet has a marked effect on reducing recurrence of calcium stone. And fluid intake shows a significant reduction in the recurrence of calcium stone.

Highlights

Nephrolithiasis or urolithiasis is the third most common disease of the urinary tract that becomes more prevalent over the past decades [1, 2]
Diet interventions were assumed as an efficient technique to prevent urinary stone formation
The results of this study indicate that water intake can reduce stone recurrence

Summary

Introduction

Nephrolithiasis or urolithiasis is the third most common disease of the urinary tract that becomes more prevalent over the past decades [1, 2]. Hematuria, and long-term complications such as chronic renal failure and hydronephrosis [5]. It is often associated with an incidence of recurrence after an initial event of 30% to 50% without prevention [6]. Present efforts to prevent the recurrence of stones are mainly focus on changing the eurine compositions and decreasing concentrations of the lithogenic factors [9]. The higher evidence-based study like systematic review of clinical value in dietary therapy in urinary stone recurrence is still lacked. We performed this systematic review and meta-analysis of randomized controlled trials (RCTs) for investigating the effects of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition

Materials and methods

Literature search and selection criteria

Results

Method

Method Normal diet

Discussion