TREATMENT EFFECT AND SAFETY OF HIGH FLUID INTAKE FOR THE PREVENTION OF INCIDENT AND RECURRENT KIDNEY STONES: A META-ANALYSIS
Wisit Cheungpasitporn Mayo Clinic, Rochester, MN, USA.
The objectives of this meta-analysis were to evaluate the treatment
effect of high fluid intake on the incidence of kidney stones, and to
assess the compliance and safety of high fluid intake to prevent kidney
A literature search was performed from inception through July 2014.
Studies that reported relative risks, odds ratios or hazard ratios
comparing the risk of kidney stones in patients with high fluid intake vs
inadequate fluid intake were included. Pooled risk ratios (RR) and 95%
confidence intervals (CI) were calculated using a random-effect,
generic inverse variance method.
Nine studies (2 randomised controlled trials [RCTs]; 7 observational
studies) with 273,954 patients were included in the meta-analysis. The
pooled RRs of kidney stones in patients 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 also
significantly associated with reduced recurrent kidney stone risk, with
RRs of 0.40 (95% CI 0.20–0.79) and 0.20 (0.09–0.44) in RCTs and
observational studies, respectively. Data on compliance and safety of
high fluid intake treatment were limited; 1 RCT reported no
withdrawals due to adverse events.
This meta-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 (~0.5 in both
cases) was high. Although increased fluid intake appears to be safe,
future studies on its safety in patients with high risk of volume overload
or hyponatremia are warranted.
The risk of kidney cancer in patients with kidney stones: a systematic review and meta-analysis.
Cheungpasitporn W QJM. 2015 Mar;108(3):205-12.
The objective of this meta-analysis was to evaluate the association between a history of kidney stones and kidney cancer.
A literature search was performed from inception until June 2014. Studies that reported odds ratios or hazard ratios comparing the risk of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) of the upper urinary tract in patients with the history of kidney stones versus those without the history of kidney stones were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
Seven studies were included in our analysis to assess the association between a history of kidney stones and RCC. The pooled RR of RCC in patients with kidney stones was 1.76 (95% CI, 1.24-2.49). The subgroup analysis found that the history of kidney stones was associated with increased RCC risk only in males (RR, 1.41 [95% CI, 1.11-1.80]), but not in females (RR, 1.13 [95% CI, 0.86-1.49]). Five studies were selected to assess the association between a history of kidney stones and TCC. The pooled RR of TCC in patients with kidney stones was 2.14 (95% CI, 1.35-3.40).
Our study demonstrates a significant increased risk of RCC and TCC in patients with prior kidney stones. However, the increased risk of RCC was noted only in male patients. This finding suggests that a history of kidney stones is associated with kidney cancer and may impact clinical management and cancer surveillance.
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