Presented by: Christopher Lo
Duke-NUS Medical School

Introduction

Many supplements have been trialed to prevent calcium oxalate (CaOx) kidney stone recurrence. The aim or our study was to summarize current knowledge and identify promising alternative therapies for the prevention of CaOx stones.

Materials

A literature search was conducted using the following databases: MEDLINE, EMBASE, Web of Science, and Google Scholar. Studies were included in this systematic review if researchers evaluated adults with a history of CaOx kidney stones. Studies that implemented pharmacotherapy or herbal supplements or uncategorized research chemical that are not in current AUA guidelines as an effective modality for treating or preventing CaOx stones were included. Review papers, case reports, pilot studies, study protocols, and conference proceedings were excluded.

Results

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Our search included 6,155 articles. After exclusion, 42 articles were included in the final analysis, which yielded six distinct categories of interventions used in the study of CaOx stone prevention. These included “medications”, “herbal supplements”, “food products and macronutrients”, “minerals and micronutrients”, “enzymes/probiotics”, and “other uncategorized”. The most promising modalities included rice-bran (decreased urinary calcium (p<0.005); stone episode rate decreased from 1.439 to 0.151/patient/year), Phyllanthus niruri (decreased urinary oxalate (p<0.001); decreased number and size of stones (p<0.001)), empagliflozin (decreased stone episode rate from 1.01 to 0.63 per 100 patient years), magnesium citrate (increased CaOx metastable limit (p < 0.05); decreased urinary oxalate (p < 0.05)), calcium-rich and magnesium-rich mineral water (increased urinary citrate (male stone formers p = 0.01); decreased urinary oxalate (male stone formers p < 0.01, female stone formers p = 0.01); decreased CaOx relative supersaturation (male stone formers p < 0.01, female stone formers p = 0.02)).

Conclusion

This systematic review is a comprehensive summary of a wide variety of modalities for the prevention of CaOx stones. We have identified several preventative therapies that may benefit CaOx stone formers with urinary abnormalities, however they have not yet been incorporated into AUA guidelines. Future research should focus on how and when to incorporate these treatments to prevent recurrent CaOx stones.

Funding

None.

Co-Authors

Qian Hui Khor, BSc (Pharmacy)(Hons)
Changi General Hospital

Victor Abdullatif, MD
Urology, Ascension Macomb Oakland Hospital

Cesar Delgado, MD
Department of Urology, UCSD Health

Yadong Lu, MD
Department of Urology, Singapore General Hospital

Jonathan Katz, MD
Department of Urology, UCSD Health

Roger Sur, MD
Department of Urology, UCSD Health