Variation in Tap Water Mineral Content in the United Kingdom: Is It Relevant for Kidney Stone Disease?

Abstract

Introduction: The dissolved mineral content of drinking water can modify a number of excreted urinary parameters, with potential implications for kidney stone disease (KSD). The aim of this study is to investigate the variation in the mineral content of tap drinking water in the United Kingdom and discuss its implications for KSD. Methods: The mineral composition of tap water from cities across the United Kingdom was ascertained from publicly available water quality reports issued by local water supply companies using civic centre postcodes during 2021. Water variables, reported as 12-monthly average values, included total water hardness and concentrations of calcium, magnesium, sodium and sulphate. An unpaired t-test was undertaken to assess for regional differences in water composition across the United Kingdom. Results: Water composition data were available for 66 out of 76 cities in the United Kingdom: 45 in England, 8 in Scotland, 7 in Wales and 6 in Northern Ireland. The median water hardness in the United Kingdom was 120.59 mg/L CaCO3 equivalent (range 16.02–331.50), while the median concentrations of calcium, magnesium, sodium and sulphate were 30.46 mg/L (range 5.35–128.0), 3.62 mg/L (range 0.59–31.80), 14.72 mg/L (range 2.98–57.80) and 25.36 mg/L (range 2.86–112.43), respectively. Tap water in England was markedly harder than in Scotland (192.90 mg/L vs. 32.87 mg/L as CaCO3 equivalent; p < 0.001), which overall had the softest tap water with the lowest mineral content in the United Kingdom. Within England, the North West had the softest tap water, while the South East had the hardest water (70.00 mg/L vs. 285.75 mg/L as CaCO3 equivalent). Conclusions: Tap water mineral content varies significantly across the United Kingdom. Depending on where one lives, drinking 2–3 L of tap water can contribute over one-third of recommended daily calcium and magnesium requirements, with possible implications for KSD incidence and recurrence.

Hydration for Adult Patients with Nephrolithiasis: Specificities and Current Recommendations

“…Concretely, physicians should advise their patients to preferentially drink water as it is free from calories, fructose, and alcohol. However, the composition of different mineral waters has to be taken into account since the mineral composition of bottled drinkable water and of tap water varies significantly [100][101][102][103][104], and may influence the urinary composition regarding stone promotors and inhibitors.…”