3 Key Takeaways
Plain English Summary- 01Core Finding
These results contrast with earlier trials, notably that of Borghi et al. in 1996, in which sustained urine output above 2 L/d significantly reduced stone recurrence.
- 02Study Evidence
Tested in a early human trial (n = 1658) at the clinical practice stage.
- 03Practical Meaning
Benefits and risks vary by individual health history — discuss with a healthcare professional.
What This Means for You
An important point to note is that these findings do not invalidate the protective role of increased urine volume but highlight the limitations of behavioral interventions alone. Effective prevention likely requires achieving a substantial increase in urine volume alongside comprehensive dietary and pharmacologic management.
The Discovery
Kidney stone prevention presents a paradox: an effective, safe, and inexpensive intervention-hydration-is widely recommended, yet difficult to implement in practice. The recent Prevention of Urinary Stones With Hydration (PUSH) trial by Desai et al. (n = 1658 patients) evaluated a behavioral strategy to increase fluid intake and reduce recurrence over 2 years but found no significant benefit compared with standard of care, despite modest increases in urinary volume. These results contrast with earlier trials, notably that of Borghi et al. in 1996, in which sustained urine output above 2 L/d significantly reduced stone recurrence. The limited efficacy (real-world effectiveness in the trial) of PUSH likely reflects insufficient adherence, with a minimal difference in urine output between active treatment and the control group, and improved baseline management in control subjects.
How It Works, Simply
This nephrology research focuses on glomerular filtration & renal tubular preservation. Researchers evaluated it using an early human trial (n = 1658) at the clinical practice stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
These results contrast with earlier trials, notably that of Borghi et al. in 1996, in which sustained urine output above 2 L/d significantly reduced stone recurrence.
- 02Study Evidence
Tested in a early human trial (n = 1658) at the clinical practice stage.
- 03Practical Meaning
Benefits and risks vary by individual health history — discuss with a healthcare professional.
Key Numbers
Biological Mechanism & Study Design
Study Design & Cohort
Early human trial
Early human trial (n = 1658) · Clinical Practice
Biological Pathway & Modality
Glomerular filtration & renal tubular preservation
Intervention: Kidney stone disease: to drink or not to drink-that is the question
Experimental Findings & Endpoints
Kidney stone prevention presents a paradox: an effective, safe, and inexpensive intervention-hydration-is widely recommended, yet difficult to implement in practice.
The recent Prevention of Urinary Stones With Hydration (PUSH) trial by Desai et al. (n = 1658 patients) evaluated a behavioral strategy to increase fluid intake and reduce recurrence over 2 years but found no significant benefit compared with standard of care, despite modest increases in urinary volume. These results contrast with earlier trials, notably that of Borghi et al. in 1996, in which sustained urine output above 2 L/d significantly reduced stone recurrence.
The limited efficacy of PUSH likely reflects insufficient adherence, with a minimal difference in urine output between active treatment and the control group, and improved baseline management in control subjects.
Clinical Translation & Practice Context
An important point to note is that these findings do not invalidate the protective role of increased urine volume but highlight the limitations of behavioral interventions alone.
Effective prevention likely requires achieving a substantial increase in urine volume alongside comprehensive dietary and pharmacologic management.
The Bottom Line · Clinical Pearl
“Effective prevention likely requires achieving a substantial increase in urine volume alongside comprehensive dietary and pharmacologic management.”
Published in Kidney International · Current Stage: Clinical Practice