Document Detail

Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline.
MedLine Citation:
PMID:  23546565     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Optimum management to prevent recurrent kidney stones is uncertain.
PURPOSE: To evaluate the benefits and harms of interventions to prevent recurrent kidney stones.
DATA SOURCES: MEDLINE, Cochrane, and other databases through September 2012 and reference lists of systematic reviews and randomized, controlled trials (RCTs).
STUDY SELECTION: 28 English-language RCTs that studied treatments to prevent recurrent kidney stones and reported stone outcomes.
DATA EXTRACTION: One reviewer extracted data, a second checked accuracy, and 2 independently rated quality and graded strength of evidence.
DATA SYNTHESIS: In patients with 1 past calcium stone, low-strength evidence showed that increased fluid intake halved recurrent composite stone risk compared with no treatment (relative risk [RR], 0.45 [95% CI, 0.24 to 0.84]). Low-strength evidence showed that reducing soft-drink consumption decreased recurrent symptomatic stone risk (RR, 0.83 [CI, 0.71 to 0.98]). In patients with multiple past calcium stones, most of whom were receiving increased fluid intake, moderate-strength evidence showed that thiazides (RR, 0.52 [CI, 0.39 to 0.69]), citrates (RR, 0.25 [CI, 0.14 to 0.44]), and allopurinol (RR, 0.59 [CI, 0.42 to 0.84]) each further reduced composite stone recurrence risk compared with placebo or control, although the benefit from allopurinol seemed limited to patients with baseline hyperuricemia or hyperuricosuria. Other baseline biochemistry measures did not allow prediction of treatment efficacy. Low-strength evidence showed that neither citrate nor allopurinol combined with thiazide was superior to thiazide alone. There were few withdrawals among patients with increased fluid intake, many among those with other dietary interventions and more among those who received thiazide and citrate than among control patients. Reporting of adverse events was poor.
LIMITATIONS: Most trial participants had idiopathic calcium stones. Nearly all studies reported a composite (including asymptomatic) stone recurrence outcome.
CONCLUSION: In patients with 1 past calcium stone, increased fluid intake reduced recurrence risk. In patients with multiple past calcium stones, addition of thiazide, citrate, or allopurinol further reduced risk.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
Howard A Fink; Timothy J Wilt; Keith E Eidman; Pranav S Garimella; Roderick MacDonald; Indulis R Rutks; Michelle Brasure; Robert L Kane; Jeannine Ouellette; Manoj Monga
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-02     Completed Date:  2013-05-22     Revised Date:  2014-03-05    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  535-43     Citation Subset:  AIM; IM    
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MeSH Terms
Allopurinol / therapeutic use
Antimetabolites / therapeutic use
Carbonated Beverages
Citrates / therapeutic use
Enzyme Inhibitors / therapeutic use
Fluid Therapy
Hydroxamic Acids / therapeutic use
Nephrolithiasis / diet therapy,  drug therapy,  prevention & control*
Practice Guidelines as Topic
Recurrence / prevention & control
Thiazides / therapeutic use
Treatment Outcome
Reg. No./Substance:
0/Antimetabolites; 0/Citrates; 0/Enzyme Inhibitors; 0/Hydroxamic Acids; 0/Thiazides; 546-88-3/acetohydroxamic acid; 63CZ7GJN5I/Allopurinol
Comment In:
Ann Intern Med. 2013 Jul 16;159(2):JC12   [PMID:  23856698 ]
Evid Based Med. 2014 Feb;19(1):12   [PMID:  23749601 ]
Erratum In:
Ann Intern Med. 2013 Aug 6;159(3):230-2

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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