Is drinking water enough to prevent kidney stones? A major experiment reveals a surprise

Listen to the article. The audio text is automated, generated by an automated system

Kidney stones are a painful condition that may disrupt daily life and send those affected to emergency departments, and the risk of recurrence is high. It affects about 1 in 11 people in the United States, and about half of those infected later experience new attacks. But a large clinical study revealed that preventing it may be more difficult than simply drinking more water.

A clinical trial coordinated by the Urinary Stone Disease Research Network, in collaboration with the Duke Clinical Research Institute, sought to find out whether a structured behavioral program could help patients increase fluid intake enough to reduce stone recurrence. The results were published in The Lancet.

Increasing fluid intake is important for preventing stone recurrence, but achieving and maintaining high daily intakes is more difficult than thought, which may explain part of the high recurrence rates, said the study's corresponding author and Duke University associate professor Dr. Charles Scales.

The researchers randomly assigned participants between a group that received usual care and a group that participated in a behavioral hydration program. The program included Bluetooth-connected smart water bottles to track drinking, personal hydration goals, reminders, financial incentives, and health coaching.

The researchers set fluid goals for each participant based on their usual urine volume and the amount needed to reach a daily urine volume of at least 2.5 liters.

Although program participants increased their fluid intake and their average urine volume increased, the improvement did not lead to a significant reduction in the frequency of symptomatic stones across the group as a whole.

The trial included 1,658 adolescents and adults from six US clinical centers, and researchers followed them for two years. The study was not limited to measuring the amount of fluid or urine volume, but also monitored the return of stones using periodic questionnaires and imaging examinations, to determine whether new stones had appeared or whether existing stones had grown.

The importance of this approach lies in the fact that it directly tested the health outcome that concerns patients, rather than being satisfied with indirect indicators that may improve without necessarily being reflected in disease recurrence rates.

Results indicate that daily adherence to drinking large amounts of fluids is challenging even with technical support, training, and reminders.

It also opens the door to the question of whether uniform hydration goals are appropriate for all patients, given that their needs vary according to age, body size, lifestyle, and health status.

Co-supervisor of the study, Dr. Gregory Tasyan, said that future prevention may require setting more appropriate goals for each patient, understanding the reasons for difficulty in adherence, in addition to developing more effective behavioral and pharmacological interventions.

The researchers believe the findings support the search for strategies beyond general advice, including tailoring fluid goals to patients' needs and addressing barriers to work and daily life, as well as studying treatments that help reduce stone formation.

However, the results do not mean that drinking fluids is not beneficial, but rather show that increasing fluid intake alone, even within an intensive program, did not achieve a significant reduction in stone recurrence in the group studied. Developing more personalized prevention methods remains an important goal to reduce recurrent pain episodes and their impact on patients' lives.