Association of water intake and hydration status with risk of kidney stone formation based on NHANES 2009-2012 cycles

Jie-Sian Wang; Hsiu-Yin Chiang; Hung-Lin Chen; Martha Flores; Ana Navas-Acien; Chin-Chi Kuo

doi:10.1017/S1368980022001033

Association of water intake and hydration status with risk of kidney stone formation based on NHANES 2009-2012 cycles

Public Health Nutr. 2022 Sep;25(9):2403-2414. doi: 10.1017/S1368980022001033. Epub 2022 May 6.

Authors

Jie-Sian Wang^#^{1

2}, Hsiu-Yin Chiang^#³, Hung-Lin Chen³, Martha Flores⁴, Ana Navas-Acien⁵, Chin-Chi Kuo^{1

3}

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, 2, Yude Road, North District, Taichung, 404, Taiwan.
² Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
³ Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.
⁴ US Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD, USA.
⁵ Department of Environmental Health Sciences, Mailman School of Public Heath, Columbia University, New York, NY, USA.

^# Contributed equally.

Abstract

Objective: Evaluating the association of water intake and hydration status with nephrolithiasis risk at the population level.

Design: It is a cross-sectional study in which daily total plain water intake and total fluid intake were estimated together with blood osmolality, urine creatinine, urine osmolality, urine flow rate (UFR), free water clearance (FWC) and urine/blood osmolality ratio (U_osm:B_osm). The associations of fluid intake and hydration markers with nephrolithiasis were evaluated using multivariable logistic regression.

Setting: General US population.

Participants: A total of 8195 adults aged 20 years or older from the National Health and Nutritional Examination Survey 2009-2012 cycles.

Results: The population medians (interquartile ranges, IQR) for daily total plain water intake and total fluid intake were 807 (336-1481) and 2761 (2107-3577) ml/d, respectively. The adjusted OR (95 % CI) of nephrolithiasis for each IQR increase in total plain water intake and total fluid intake were 0·92 (95 % CI 0·79, 1·06) and 0·84 (95 % CI 0·72, 0·97), respectively. The corresponding OR of nephrolithiasis for UFR, blood osmolality, U_osm:B_osm and urine creatinine were 0·87 (95 % CI 0·76, 0·99), 1·18 (95 % CI 1·06, 1·32), 1·38 (95 % CI 1·17, 1·63) and 1·27 (95 % CI 1·11, 1·45), respectively. A linear protective relationship of fluid intake, UFR and FWC with nephrolithiasis risk was observed. Similarly, positive dose-response associations of nephrolithiasis risk with markers of insufficient hydration were identified. Encouraging a daily water intake of >2500 ml/d and maintaining a urine output of 2 l/d was associated with a lower prevalence of nephrolithiasis.

Conclusion: This study verified the beneficial role of general water intake recommendations in nephrolithiasis prevention in the general US population.

Keywords: Fluid intake; Hydration status; Kidney stone; Nephrolithiasis; Urine output; Water intake.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Biomarkers / urine
Creatinine
Cross-Sectional Studies
Drinking* / physiology
Humans
Kidney Calculi* / epidemiology
Kidney Calculi* / etiology
Kidney Calculi* / prevention & control
Nutrition Surveys
Osmolar Concentration

Substances

Biomarkers
Creatinine