Water Hardness and Urinary Stone Disease

Shuster, JJ; Finlayson, Birdwell; Scheaffer, Richard L.; Sierakowski, Robert L.; Zoltek, John; Dzegede, Sylvi A.

doi:10.1016/s0022-5347(17)52951-1

Cited by 58 publications

(26 citation statements)

References 4 publications

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“…11 It has been hypothesized that calcium binds with oxalate and interferes with the absorption of oxalate in the gastrointestinal tract, leading to lower concentrations of oxalate in urine and, consequently, a decreased risk of stone formation. 17 Similarly to a study of non-SCI individuals, 18 the present study is unable to provide statistical signi®cance to support ®ndings from ecological studies that persons living in areas with hard and very hard water had a lower stone incidence than those having soft water, 9,10 although the trend we noted is consistent with these investigations. This nonsigni®cance, nevertheless, might be partly explained by the relatively homogenous distribution in water hardness and mineral content within the same state (more than 50% of study participants used soft water).…”

Section: Discussioncontrasting

confidence: 73%

Urine specific gravity and water hardness in relation to urolithiasis in persons with spinal cord injury

et al. 2001

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Study design: A matched case-control study. Objectives: To clarify the in¯uence of urine speci®c gravity and drinking water quality on the formation of urinary stones in persons with spinal cord injury (SCI). Setting: A rehabilitation center within a university hospital. Methods: Between 1992 and 1998, 63 stone cases (31 kidney, 27 bladder, and ®ve both) and 289 age-duration-matched controls were recruited from a cohort of SCI patients enrolled in an on-going longitudinal study. Data on urine speci®c gravity and other characteristics of study participants were retrieved from the database and medical charts. Community water supply information was provided by the Alabama Department of Environmental Management. Multivariable conditional logistic regression analysis was performed to evaluate the association with stone formation. Results: SCI individuals who had urinary stones were more likely than control subjects to use indwelling catheters and have decreased renal function. The occurrence of stones was not signi®cantly related to gender, race, severity of injury, urinary tract infection, nor urine pH. After controlling for the potential confounding from other factors, a continuously increasing stone occurrence with increasing speci®c gravity was observed (P=0.05); this association was stronger for kidney (odds Ratio [OR]=1.8 per 0.010 g/cm 3 ) versus bladder stones (OR=1.2) and for recurrent (OR=2.0) versus ®rst stones (OR=1.5). Increased water hardness was not signi®cantly associated with a decreased stone occurrence. Conclusions: Study results suggest that maintaining urine speci®c gravity below a certain level might reduce the occurrence of urinary stones. This could be easily achieved by using a dipstick for self-feedback along with appropriate¯uid intake. For persons with SCI who are at an increased risk of a devastating stone disease, this prophylactic approach could be very cost-eective; however, this requires further con®rmation. Spinal Cord (2001) 39, 571 ± 576Keywords: spinal cord injury; calculi; speci®c gravity; hardness IntroductionUrinary stone disease is a frequent complication of spinal cord injury (SCI). It has been estimated that within 8 years after injury, approximately 7% of SCI patients would develop their ®rst kidney stones, 1 whereas 36% would have bladder stones.2 Urinary calculi can lead to obstruction, sepsis, deterioration of renal function, and even loss of the aected kidney. 3,4 An eective method to prevent stones is necessary to alleviate the threat, which they pose to the health and welfare of many SCI survivors.The high stone incidence in the SCI population has been thought to be attributable to immobilization hypercalciuria and an increased susceptibility to urinary tract infection (UTI).1 Most injury-related determinants of urinary stones, including years since injury, severity of injury, and methods of bladder management, may re¯ect one or both of these pathways. However, because UTI is much more common than urinary stones in persons with SCI, infection may be a necessary compon...

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Section: Discussioncontrasting

confidence: 73%

Urine specific gravity and water hardness in relation to urolithiasis in persons with spinal cord injury

et al. 2001

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“…En la región de Rockie la media de la DT fue 58 ppm, en la región de Carolina la DT fue de 13.3 ppm, comparada con nuestra media de DT de 485 ppm. 11,22 Aunque la Organización Mundial para la Salud no tiene valores de referencia recomienda 200 ppm como límite aceptable en la dureza total del agua empleada para consumo humano y 500 ppm como límite 24 La dureza total de todas las muestras de agua obtenidas en nuestro estudio excedió el límite aceptable establecido nacional e internacionalmente (200 ppm) y 20% de las muestras rebasaron el límite de tolerancia (500 ppm). Por otra parte, Kohri encontró una asociación positiva entre la relación magnesio/calcio del agua empleada para consumo humano y la prevalencia de los cálculos renales de estruvita en regiones de basalto y roca sedimentaria en Japón.…”

Section: Discussionunclassified

“…Conviene señalar que aquellos estudios que reportan que la dureza del agua no contribuye al desarrollo de la litiasis urinaria se hicieron en comunidades en las que la dureza total no superaba las 400 ppm. 10,11 Por el contrario, la Comisión Nacional del Agua (México) reconoce determinaciones de durezas totales por arriba de 800 ppm en el agua empleada para consumo humano, en algunas comunidades del estado de Yucatán. 12 Por lo anterior, se decidió aplicar una encuesta para determinar la prevalencia de urolitiasis en la población del estado, y evaluar los antecedentes familiares y la dureza elevada del agua como posibles factores de riesgo para el desarrollo de la enfermedad.…”

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Prevalencia y factores de riesgo en Yucatán, México, para litiasis urinaria

Medina-Escobedo¹,

Zaidi²,

León³

et al. 2002

Salud pública Méx

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“…These studies cannot, however, be considered to be definitive, inasmuch as they were conducted on hospitalized patients, without reference to a control group, and they did not take risk-provoking environmental and dietetic factors into consideration. Moreover, other studies have been unable to confirm these findings [35, 36, 37, 38], and still others have attributed importance to the magnesium-calcium ratio found in tap water [39, 40]. …”

Section: What Type Of Fluid Is Important?mentioning

confidence: 99%

Urine Volume: Stone Risk Factor and Preventive Measure

Borghi¹,

Meschi²,

Schianchi³

et al. 1998

Nephron

108

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Background: A high fluid intake is the oldest existing treatment for kidney stones, and, up until a few decades ago, it was the only preventive measure at the physician’s disposal for stone recurrences. Methods: Using the data available in literature and partly unpublished personal research, we examine the role of urine volume as a stone risk factor, its impact on calcium crystallization mechanisms and its real importance as a means of prevention. Results: To sum up, the most important findings are: (1) a low urine volume must be considered as a real risk factor, both as regards the onset of renal calculi and stone relapses; (2) an increase in urine volume induced by a high water intake produces favourable effects on the crystallization of calcium oxalate and does not reduce the activity of natural inhibitors; (3) a sufficiently high intake of water and probably other fluids such as coffee, tea, beer and wine has a preventive effect on nephrolithiasis and its recurrence, and (4) the role of fruit juice is still to be defined. Conclusions: A high intake of fluids, especially water, is still the most powerful and certainly the most economical means of prevention of nephrolithiasis, and it is often not used to advantage by stone formers.

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Water Hardness and Urinary Stone Disease

Cited by 58 publications

References 4 publications

Urine specific gravity and water hardness in relation to urolithiasis in persons with spinal cord injury

Urine specific gravity and water hardness in relation to urolithiasis in persons with spinal cord injury

Prevalencia y factores de riesgo en Yucatán, México, para litiasis urinaria

Urine Volume: Stone Risk Factor and Preventive Measure

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