title: Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid in the management of hypercalciuric stone formers.
abstract: OBJECTIVE
  To investigate the use of fish oil in the dietary management of hypercalciuric stone formers. Prostaglandins have been linked to urinary calcium excretion, suggesting a role for omega-3 fatty acids in the treatment of hypercalciuric urolithiasis.
  
  
  METHODS
  We retrospectively studied a cohort of patients treated at our stone clinics from July 2007 to February 2009. Patients' urinary risk factors for stone disease were evaluated with pre- and post-intervention 24-hour urine collections. All patients received empiric dietary recommendations for intake of fluids, sodium, protein, and citric juices. All subjects with hypercalciuria (urinary calcium>250 mg/d for males or >200 mg/d for females) on at least two 24-hour urine collections were counseled to supplement their diet with fish oil (1200 mg/d).
  
  
  RESULTS
  Twenty-nine patients were followed for 9.86±8.96 months. The mean age was 43.38±13.78 years. Urinary calcium levels decreased in 52% of patients, with 24% converting to normocalciuria. The average urinary calcium (mg/d) decreased significantly from baseline (329.27±96.23 to 247.47±84.53, P<.0001). Urinary oxalate excretion decreased in 34% of patients. The average urinary oxalate (mg/d) decreased significantly from baseline (45.40±9.90 to 32.9±8.21, P=.0004). Urinary citrate (mg/d) increased in 62% of subjects from baseline (731.67±279.09 to 940.22±437.54, P=.0005). Calcium oxalate supersaturation decreased in 38% of the subjects significantly from baseline (9.73±4.48 to 3.68±1.76, P=.001).
  
  
  CONCLUSIONS
  Omega-3 fatty acids combined with empiric dietary counseling results in a measurable decrease in urinary calcium and oxalate excretion and an increase in urinary citrate in hypercalciuric stone formers.
authors: Department of Regional Urology, The Cleveland Clinic, Cleveland, OH 44195, USA.
authors: Omar
authors: O
authors: Ortiz-Alvarado
authors: Ricardo
authors: R
authors: Miyaoka
authors: Carly
authors: C
authors: Kriedberg
authors: David A
authors: DA
authors: Leavitt
authors: Angela
authors: A
authors: Moeding
authors: Michelle
authors: M
authors: Stessman
authors: Manoj
authors: M
authors: Monga
mesh_terms: D000328:Adult; D002118:Calcium / Q000652:urine; D002951:Citrates / Q000652:urine; D003131:Combined Modality Therapy; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000627:therapeutic use*; D004341:Drug Evaluation; D015118:Eicosapentaenoic Acid / Q000627:therapeutic use*; D005260:Female; D005395:Fish Oils / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D053565:Hypercalciuria / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010070:Oxalates / Q000652:urine; D011453:Prostaglandins / Q000378:metabolism; D012189:Retrospective Studies; D052878:Urolithiasis / Q000178:diet therapy / Q000209:etiology / Q000517:prevention & control* / Q000652:urine
chemical_list: D002951:Citrates; D016861:Cyclooxygenase Inhibitors; D005395:Fish Oils; D010070:Oxalates; D011453:Prostaglandins; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid; D002118:Calcium