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Dietary Risk Factors for Incident and Recurrent Symptomatic Kidney Stones



      To compare dietary factors between incident symptomatic stone formers and controls, and among the incident stone formers, to determine whether dietary factors were predictive of symptomatic recurrence.

      Patients and Methods

      We prospectively recruited 411 local incident symptomatic kidney stone formers (medical record validated) and 384 controls who were seen at Mayo Clinic in Minnesota or Florida between January 1, 2009, and August 31, 2018. Dietary factors were based on a Viocare, Inc, food frequency questionnaire administered during a baseline in-person study visit. Logistic regression compared dietary risk factors between incident symptomatic stone formers and controls. Incident stone formers were followed up for validated symptomatic recurrence in the medical record. Cox proportional hazards models estimated risk of symptomatic recurrence with dietary factors. Analyses adjusted for fluid intake, energy intake, and nondietary risk factors.


      In fully adjusted analyses, lower dietary calcium, potassium, caffeine, phytate, and fluid intake were all associated with a higher odds of an incident symptomatic kidney stone. Among incident stone formers, 73 experienced symptomatic recurrence during a median 4.1 years of follow-up. Adjusting for body mass index, fluid intake, and energy intake, lower dietary calcium and lower potassium intake were predictive of symptomatic kidney stone recurrence. With further adjustment for nondietary risk factors, lower dietary calcium intake remained a predictor of recurrence, but lower potassium intake only remained a predictor of recurrence among those not taking thiazide diuretics or calcium supplements.


      Enriching diets in stone formers with foods high in calcium and potassium may help prevent recurrent symptomatic kidney stones.

      Abbreviations and Acronyms:

      AIC (Akaike Information Criterion), BMI (body mass index), FFQ (food frequency questionnaire), IQR (interquartile range), ROKS (Recurrence of Kidney Stone)
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      Linked Article

      • The Optimal Dietary Calcium Intake for Preventing Incident and Recurrent Symptomatic Kidney Stone Disease
        Mayo Clinic ProceedingsVol. 97Issue 8
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          Until the early 1990s, it was presumed that dietary calcium intake should be limited for preventing the onset and recurrence of calcium kidney stone formation, assuming that frequent consumption of milk and dairy products could unfavorably influence urinary calcium excretion. However, a prospective investigation conducted on 45,619 men without baseline history of kidney stones, published in 1993, showed an inverse relationship between baseline dietary calcium intake, assessed by a semiquantitative food frequency questionnaire, and the risk of incident symptomatic kidney stone disease after a 4-year follow-up period.
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