title: Treatment effect, adherence, and safety of high fluid intake for the prevention of incident and recurrent kidney stones: a systematic review and meta-analysis.
abstract: BACKGROUND
  The objective of this systematic review and meta-analysis were to evaluate the effectiveness of high fluid intake for the prevention of incident and recurrent kidney stones, as well as its adherence and safety.
  
  
  METHODS
  A literature search was performed encompassing 1980 through July 2014. Studies that reported relative risks, odds ratios, or hazard ratios comparing the risk of kidney stone events in patients with high vs inadequate fluid intake were included. Pooled risk ratios (RRs) and 95 % confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Nine studies [2 randomized controlled trials (RCTs) with 269 patients; 7 observational studies with 273,685 individuals] were included in the meta-analysis. Pooled RRs of kidney stones in individuals with high-fluid intake were 0.40 (95 % CI 0.20-0.79) and 0.49 (0.34-0.71) in RCTs and observational studies, respectively. High fluid intake was significantly associated with reduced risk of recurrent kidney stones: RRs 0.40 (95 % CI 0.20-0.79) and 0.20 (0.09-0.44) in RCTs and observational studies, respectively. Adherence and safety data on high fluid intake treatment were limited; 1 RCT reported no withdrawals due to adverse events.
  
  
  CONCLUSIONS
  This analysis demonstrated a significantly reduced risk of incident kidney stones among individuals with high fluid consumption. High fluid consumption also reduced the risk of recurrent kidney stones. Furthermore, the magnitude of risk reduction was high. Although increased water intake appears to be safe, future studies on its safety in patients with high risk of volume overload or hyponatremia may be indicated.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Cardiorenal Department, Medical Affairs, Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rossetti
authors.affiliation: Cardiorenal Department, Medical Affairs, Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Friend
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Erickson
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Lieske.john@mayo.edu.|Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA. Lieske.john@mayo.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Lieske
mesh_terms: D016009:Chi-Square Distribution; D004326:Drinking; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014554:Urination
keywords: Fluid intake; Hyponatremia; Kidney stones; Meta-analysis; Water