InstitutBMKEffect of a bicabonate-rich mineral water in patients with recurrent renal stone formation a controlled double-blind study

Chr. Gutenbrunner, U. Smorag, O. Karaglle, F. Candir, H. Becker, U. Jonas

Professor Christoph Gutenbrunner, MD, PhD,Clinic for Physical Medicine and RehabilitationHanover Medical SchoolCarl-Neuberg-Str. 1 D-30625 Hannovergutenbrunner.christoph@mh-hannover.de

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKIntroduction In the industrialised countries urolithiasis is a frequent disease Prevalence in Germany: 4.7% Incidence: 1.47% The rate of relapses is high: 50-60% The extra-corporal shock-wave therapy is not free of complications For that reason an effective metaphylaxis is of major importance

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKIntroduction A basic principle of the metaphylaxis of urolitioasis is the dilution of the urine by an increase of the fluid intake Additional principles are the reduction of the excretion of stone forming substances in the urine: calcium, oxalate, uric acid and others the enhancement of the excretion of inhibitors: magnesium, citrate and others the reduction of the crystallisation risk by influencing the pH of the urine (dependent on the type of renal stones)

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

frund

InstitutBMKIntroduction From experimental studies it is known that bicarbonate waters increase the urinary pH and the citrate excretion magnesium-rich waters increase the urinary excretion of magnesium the increase of calcium-excretion is over- compensated by the increase of diuresis Only a few studies were performed in patients Most studies dealt with the problem of calcium-waters Therefore we studied the effect of a magnesium- and bicarbonate-rich mineral water

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

frund

InstitutBMKMaterial and Methods Design of the Study:- double-blind controlled study- cross-over-design Patients:- Patients with multi-episodic CaOx-urolithiasis (n=34)- males/females: 30/4- number of stone episodes: 3.0 1.6 Setting:- Everyday activities- no standardisation of the diet- nutrition protocol

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKMaterial and Methods Interventions:- 1.5 l/d bicarbonated water (2,673 mg HCO3-/l; 175 mg Mg++/l; 116 mg Ca++/l)- 1.5 l/d low-mineralized water (98 mg HCO3-/l8 mg Mg++/l; 38 mg Ca++/l)- 1.400 ml of each water for three consecutive days- all waters in the same type of bottles, colour code- distance between drinking periods: one week Main Outcome Parameters: - 24-h-urine samples before drinking, 3rd day of drinking- urinary pH (24-h-urine)- magnesium- and citrate-excretion- supersaturation CaOx and of other types of urinary stones

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKResults

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKResults

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKResults

Supersaturation CaOxSupersaturation Uric acidSupersaturation CaPO4ControlsBaseline3,41 0,311,22 0,131,33 0,19Drinking2,44 0,280,70 0,071,01 0,15Bicarbonate WaterBaseline3,39 0,341,03 0,121,44 0,23Drinking2,42 0,290,24 0,042,01 0,24p (controls vs. bicarbonate water)*)0,8010,0010,001p (baseline vs. Drinking)**) Controls0,0010,0010,014Bicarbonate Water0,0010,0010,023

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKPatients with high riskp1 = Significance between verum and controls p2 = Significance between baseline and drinking period

Low mineralised water bicarbonate rich waterBaselineIntervention BaselineIntervention SignificanceCitrate-concentration (mmol/l)1,73 0,881,18 0,431,61 0,721,60 0,56p1 = 0,016**p2 = 0,001***p2 = 0,884Magnesium-concentration (mmol/l)2,18 0,921,53 0,492,09 0,881,99 065p1 = 0,033*p2 = 0,001***p2 = 0,961Calcium-concentration (mmol/l)3,15 1,682,17 1,083,07 1,372,57 1,27p1 = 0,245p2=0,001***p2=0,007**Oxalate-concentration (mmol/l)0,29 0,090,21 0,100,28 0,120,21 0,09p1 = 0,879p2 = 0,002**p2 = 0,001***Uric acid-concentration (mmol/l)1,77 0,671,21 0,321,49 0,371,36 0,40p1 = 0,152p2 = 0,001***p2 = 0,140Phosphate-concentration (mmol/l)15,79 6,4810,86 3,2916,12 3,299,80 3,42p1 = 0,231p2 = 0,001***p2 = 0,001***

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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InstitutBMKConclusion Both waters significantly reduce the renal stone formation risk in patients with relapsing CaOx-urolithiasis The mineral water additionally increases the urinary pH as well as the excretion of magnesium and citrate The mineral water is effective even in cases with high risk of stone formation (hypercalciuria, hyperoxaluria) Bicarbonated waters should be used in patients with combined stones containing CaOx and uric acid or in uric acid stones but not in in patients with phosphate stones

Medizinische Hochschule Hannover

Institut Balneologie Medizinische Klimatologie

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