Does pantothenic acid (PA) as d-calcium-pantothenate increase the risk of kidney stones?

Pantothenic Acid and Kidney Stone Risk

Pantothenic acid (vitamin B5) as d-calcium-pantothenate does not appear to increase the risk of kidney stones based on available evidence. While the calcium component theoretically could contribute to stone formation, current guidelines do not identify pantothenic acid supplements as a risk factor for kidney stones.

Calcium Supplements and Kidney Stone Risk

General Principles

• The American Urological Association recommends adequate calcium intake of 1,000-1,200 mg/day from dietary sources, as higher dietary calcium actually reduces stone risk by binding oxalate in the gut 1
• However, calcium supplements may have different effects than dietary calcium:
  • Calcium supplements were associated with a 20% increased risk of stone formation in older women in observational studies 2
  • The timing of calcium intake is critical - supplements taken between meals (rather than with meals) may increase risk due to reduced dietary oxalate binding 2

D-Calcium-Pantothenate Considerations

• D-calcium-pantothenate contains calcium, but in much smaller amounts than dedicated calcium supplements
• No specific evidence links pantothenic acid supplements to increased kidney stone risk
• A study in populations with low oxalate intake found that calcium supplements resulted in:
  • Increased urinary calcium (expected)
  • Decreased urinary oxalate (beneficial)
  • Increased urinary citrate (beneficial)
  • No significant change in calcium oxalate activity products (overall risk) 3

Risk Factors for Kidney Stone Formation

The primary risk factors for kidney stone formation according to guidelines include:

• High urinary calcium: Reduce non-dairy animal protein intake and sodium intake 2, 1
• High urinary oxalate: Avoid high-oxalate foods and vitamin C supplements 2, 1
• Low urinary citrate: Increase fruit and vegetable intake 2
• Low urine volume: Increase fluid intake to maintain urine volume >2 L/day 2, 1

Clinical Recommendations

For patients taking pantothenic acid as d-calcium-pantothenate:

1. Take supplements with meals to maximize oxalate binding and minimize potential risk 2
2. Maintain adequate hydration with a target urine output >2 liters/day 1
3. Follow general kidney stone prevention guidelines:
   • Reduce sodium intake to <2,300 mg/day 1
   • Limit animal protein to 5-7 servings per week 2, 1
   • Increase potassium-rich foods 1
   • Reduce sucrose/carbohydrate intake 1

Monitoring Considerations

For patients with a history of kidney stones who require pantothenic acid supplementation:

• Consider 24-hour urine collection before and after starting supplementation to assess any changes in urinary calcium, oxalate, citrate, and overall stone risk 1
• If urinary supersaturation of calcium salts increases during supplementation, consider discontinuing the supplement or adjusting the dosage/timing 2

Important Caveats

• Vitamin C supplements (≥1,000 mg/day) increase urinary oxalate by 22% and should be avoided in calcium stone formers 1
• Vitamin D supplementation may worsen risk in patients predisposed to hypercalciuria 1, 4
• The effect of calcium supplements varies among individuals - some may be more susceptible to increased stone risk than others 4