From the Guidelines
The best lifestyle interventions for preventing and managing kidney stones include increasing fluid intake to at least 2 liters of water daily, as recommended by the American College of Physicians (ACP) 1.
Key Lifestyle Interventions
- Increasing fluid intake to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis, as this has been shown to reduce stone recurrence 1.
- Reducing dietary oxalate, reducing dietary animal protein and other purines, and maintaining normal dietary calcium, as these dietary changes can help decrease concentrations of lithogenic factors and increase concentrations of inhibitors of stone formation 1.
- Avoiding foods high in oxalate such as spinach, rhubarb, and chocolate, and limiting purine-rich foods like red meat and shellfish for those with uric acid stones, as these can increase the risk of stone formation 1.
Importance of Tailoring Interventions
These interventions should be tailored based on stone composition, which can be determined through stone analysis or 24-hour urine collection, to maximize their effectiveness in preventing and managing kidney stones 1.
Additional Considerations
Weight management is also important as obesity increases stone risk, and citrus fruits and juices (especially lemon and orange) can help by increasing urinary citrate, which inhibits stone formation 1. By implementing these evidence-based lifestyle changes, most patients can reduce their risk of recurrence by 50% or more.
From the FDA Drug Label
Patients were instructed to stay on a sodium restricted diet (100 mEq/day) and to reduce oxalate intake (limited intake of nuts, dark roughage, chocolate and tea). A moderate calcium restriction (400-800 mg/day) was imposed on patients with hypercalciuria
- Lifestyle interventions that are supported by high-quality evidence for preventing and managing kidney stones include:
- Sodium restriction: limiting sodium intake to 100 mEq/day
- Oxalate reduction: reducing intake of foods high in oxalate, such as nuts, dark roughage, chocolate, and tea
- Moderate calcium restriction: limiting calcium intake to 400-800 mg/day in patients with hypercalciuria These interventions were associated with a reduced stone formation rate and increased urinary citrate excretion in patients with calcium oxalate nephrolithiasis 2
From the Research
Lifestyle Interventions for Preventing and Managing Kidney Stones
The following lifestyle interventions are supported by high-quality evidence for preventing and managing kidney stones:
- Increasing fluid intake to achieve a daily urine output of 2 liters 3, 4, 5, 6
- Moderate dietary salt restriction to limit urinary calcium excretion 3, 5
- Dietary calcium intake of at least 800 mg/day to prevent negative calcium balance and bone mineral loss 3, 5
- Low-normal protein intake to decrease calciuria and preserve bone mass 3
- Increasing intake of fruits and vegetables, excluding those with high oxalate content, to increase citrate excretion and protect against stone formation 3
- Avoiding excessive intake of animal protein and purine to reduce urinary uric acid excretion 3, 7
- Urine alkalinization to pH values between 6.2 and 6.8 to prevent uric acid stone formation 7
Specific Considerations for Different Patient Groups
- For patients with hypercalciuria, a diet with a calcium content of at least 1 g/day and low protein-low sodium may be protective against stone formation 3
- For patients with hyperoxaluria, a diet low in oxalate and/or a calcium intake of 800-1200 mg/day may reduce urinary oxalate excretion 3
- For patients with hyperuricosuria, a low-purine diet and urinary alkalinization may be effective in preventing stone formation 3, 7
- For elderly patients, a restriction of sodium intake and an increase in potassium, magnesium, and citrate intake may be beneficial in reducing urinary risk factors for stone formation 3
- For children, a balanced consumption of fruits and vegetables and a low consumption of chocolate and cola, as well as adequate fluid intake, may be recommended 3