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Am J Kidney Dis. 2014 Mar;63(3):456-63. doi: 10.1053/j.ajkd.2013.11.022.

Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets.

Author information

1
Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2
Nephrology Section, New York Harbor VA Healthcare System, New York, NY; Nephrology Division, New York University School of Medicine, New York, NY.
3
Harold Simmons Center for Kidney Disease Research & Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California, Irvine, Irvine, CA.
4
Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: basiri@unrc.ir.

Abstract

BACKGROUND:

Patients with nephrolithiasis and hyperoxaluria generally are advised to follow a low-oxalate diet. However, most people do not eat isolated nutrients, but meals consisting of a variety of foods with complex combinations of nutrients. A more rational approach to nephrolithiasis prevention would be to base dietary advice on the cumulative effects of foods and different dietary patterns rather than single nutrients.

STUDY DESIGN:

Randomized controlled trial.

SETTING & PARTICIPANTS:

Recurrent stone formers with hyperoxaluria (urine oxalate > 40 mg/d).

INTERVENTION:

The intervention group was asked to follow a calorie-controlled Dietary Approaches to Stop Hypertension (DASH)-style diet (a diet high in fruit, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, sweets, and meat), whereas the control group was prescribed a low-oxalate diet. Study length was 8 weeks.

OUTCOMES:

Primary: change in urinary calcium oxalate supersaturation.

SECONDARY:

Changes in 24-hour urinary composition.

RESULTS:

57 participants were randomly assigned (DASH group, 29; low-oxalate group, 28). 41 participants completed the trial (DASH group, 21; low-oxalate group, 20). As-treated analysis showed a trend for urinary oxalate excretion to increase in the DASH versus the low-oxalate group (point estimate of difference, 9.0mg/d; 95% CI, -1.1 to 19.1mg/d; P=0.08). However, there was a trend for calcium oxalate supersaturation to decrease in the DASH versus the low-oxalate group (point estimate of difference, -1.24; 95% CI, -2.80 to 0.32; P=0.08) in association with an increase in magnesium and citrate excretion and urine pH in the DASH versus low-oxalate group.

LIMITATIONS:

Limited sample size, as-treated analysis, nonsignificant results.

CONCLUSIONS:

The DASH diet might be an effective alternative to the low-oxalate diet in reducing calcium oxalate supersaturation and should be studied more.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01650935.

KEYWORDS:

Dietary Approaches to Stop Hypertension (DASH) diet; calcium oxalate supersaturation; clinical trial; hyperoxaluria; kidney stone; nephrolithiasis; oxalate

PMID:
24560157
DOI:
10.1053/j.ajkd.2013.11.022
[Indexed for MEDLINE]

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