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Dietary changes, including increased fluid intake, are among
the recommendations in ACP's new evidence-based guideline
Guideline | Read
Philadelphia, November 4, 2014 -- In a new evidence-based
clinical practice guideline published today in Annals of Internal
Medicine, the American College of Physicians (ACP) recommends that
people who have had a kidney stone increase their fluid intake to
achieve at least two liters of urine per day to prevent another
kidney stone from forming. If increased fluid intake fails to
reduce the formation of stones, ACP recommends adding medication
with a thiazide diuretic, citrate, or allopurinol.
"Increased fluid intake spread throughout the day can decrease
stone recurrence by at least half with virtually no side effects,"
said Dr. David Fleming, president, ACP. "However, people who
already drink the recommended amount of liquids, or when increased
fluid intake is contraindicated, should not increase their fluid
The evidence did not show any difference between tap water
compared to a specific brand of mineral water. The evidence
indicated that a decrease in consumption of soft drinks acidified
by phosphoric acid, such as colas, is associated with a reduced
risk of stone recurrence. (Fruit-flavored soft drinks are often
acidified by citric acid.)
The evidence showed that thiazide diuretics, citrates, or
allopurinol effectively reduced recurrence of stones formed of
calcium -- the most common type of kidney stone -- in patients with
at least two past stones. No studies directly compared the drugs to
The guideline authors note that doctors also recommend dietary
changes to prevent recurring kidney stones, including reducing
dietary oxalate (e.g., chocolate, beets, nuts, rhubarb, spinach,
strawberries, tea, and wheat bran), reducing dietary animal protein
and purines, and maintaining normal dietary calcium.
A kidney stone occurs when tiny crystals in urine stick together
to form a stone. About 13 percent of men and 7 percent of women in
the United States will develop a kidney stone during their
lifetime. Studies show that the recurrence rate of kidney stones
within five years of an initial stone ranges from 35 to 50 percent
ACP's recommendations are based on published literature in the
English language on this topic from 1948 through March 2014.
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 141,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
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