Intervention Review

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Dietary interventions for preventing complications in idiopathic hypercalciuria

  1. Joaquin Escribano1,*,
  2. Albert Balaguer2,
  3. Marta Roqué i Figuls3,
  4. Albert Feliu1,
  5. Natalia Ferre4

Editorial Group: Cochrane Kidney and Transplant Group

Published Online: 11 FEB 2014

Assessed as up-to-date: 23 APR 2013

DOI: 10.1002/14651858.CD006022.pub4


How to Cite

Escribano J, Balaguer A, Roqué i Figuls M, Feliu A, Ferre N. Dietary interventions for preventing complications in idiopathic hypercalciuria. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD006022. DOI: 10.1002/14651858.CD006022.pub4.

Author Information

  1. 1

    Hospital Universitari St Joan de Reus, Department of Pediatrics, Reus, Catalonia, Spain

  2. 2

    Universitat Internacional de Catalunya, Department of Pediatrics. Hospital General de Catalunya., Barcelona, CATALONIA, Spain

  3. 3

    CIBER Epidemiología y Salud Pública (CIBERESP), Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Catalunya, Spain

  4. 4

    Universitat Rovira i Virgili, Pediatric Research Unit, School of Medicine, Tarragona, Spain

*Joaquin Escribano, Department of Pediatrics, Hospital Universitari St Joan de Reus, Universitat Rovira i Virgili, St Joan s/n, Reus, Catalonia, 43201, Spain. JESCRIBANO@GRUPSAGESSA.COM.

Publication History

  1. Publication Status: New
  2. Published Online: 11 FEB 2014

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Characteristics of included studies [ordered by study ID]
Borghi 2002

Methods
  • Study design: parallel RCT
  • Time frame: June 1993 to December 1994
  • Study duration: 5 years


Participants
  • Setting: single centre
  • Country: Italy
  • Men with idiopathic hypercalciuria (urinary calcium excretion, > 300 mg/d (7.5 mmol/d) on an unrestricted diet, recurrent formation of calcium oxalate stones (at least two documented events (colic episodes with expulsion of stones or radiographic evidence of retained stones)), no previous visit to a stone disease centre, no current treatment for the prevention of recurrent stones except for the advice to increase water intake
  • Number: treatment group 1 (60); treatment group 2 (60)
  • Mean age ± SD (years): treatment group 1 (45.4 ± 10.9); treatment group 2 (44.8 ± 9.2)
  • Sex (M/F): all male
  • Exclusion criteria: primary hyperparathyroidism, primary hyperoxaluria, enteric hyperoxaluria, bowel resection, inflammatory bowel disease, renal tubular acidosis, sarcoidosis, or sponge kidney


InterventionsTreatment group 1

  • Low calcium diet: 10 mmol/d
  • Water intake: 2 to 3 L/d


Treatment group 2

  • Normal-to-high intake of calcium: 30 mmol/d
  • Low protein diet: < 15% of total energy
  • Low salt diet: < 50 mmol/d
  • Water intake: 2 to 3 L/d


Outcomes
  • Stone formation: time to first symptomatic or radiographically identified stone
  • Changes in calcium and oxalate excretion, calcium oxalate product, and relative calcium oxalate saturation


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandomisation generated by an investigator. Random number sequence (odd number group A and even number group B)

Allocation concealment (selection bias)Low riskRandom number sequence enclosed in sealed, numbered envelopes

Blinding (performance bias and detection bias)
All outcomes
High riskDue to the nature of the intervention, patients and researchers were not blinded

Incomplete outcome data (attrition bias)
All outcomes
Low riskDrop-outs reported: 17 did not complete the study: 9 patients in Group A (hypertension (7) died (2)); 8 in Group B (hypertension (1), gout (1), embolism (1), lost to follow-up (2), withdrew consent (3))

Selective reporting (reporting bias)Low riskFree of suggestion of selective outcome reporting

Other biasLow riskApparently free of other problems that could put it at a risk of bias

Coe 1992

Methods
  • Study design: cross-over RCT. Two treatment phases 28 days in length (periods I and 2), 2, 7-day baseline periods and a 7-day washout period at the start of the study and again between treatments
  • Time frame: NS
  • Study duration: 76 days


Participants
  • Setting: single centre
  • Country: USA
  • Healthy, relatives of hypercalciuric stone-forming patients, without any clinical manifestation
  • Number: 12
  • Age 18 to 30 years
  • Sex (M/F): 6/6
  • Exclusion criteria: NS


InterventionsTreatment group 1

  • 2% milk: 2 x 8 oz glasses/d


Treatment group 2

  • Orange juice + calcium citrate malate salt supplement: 2 x 6 oz glasses/d (calcium supplement: 600 mg/d)


Outcomes
  • Reduction in 24 h urine calciuria and oxaluria


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskRandomisation method not described

Allocation concealment (selection bias)Unclear riskAllocation concealment not described

Blinding (performance bias and detection bias)
All outcomes
High riskNo blinding of intervention and outcome measurement

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskDrop-outs not specified

Selective reporting (reporting bias)Low riskApparently free of selective outcome reporting

Other biasLow riskApparently free of other factors that could influence bias

Gleeson 1990

Methods
  • Study design: parallel RCT
  • Time frame: NS
  • Study duration: 3 weeks


Participants
  • Setting: single centre
  • Country: USA
  • Patients with a previous history of renal calculus formation and know hypercalciuria (> 200 mg/d)
  • Number: treatment group (9); control group (8)
  • Age range: 39 to 65 years
  • Sex (M/F): 16/1
  • Exclusion criteria: NS


InterventionsTreatment group

  • Calcium (301 mg) and oxalate (202 mg) diet
  • Unprocessed wheat bran: 78.2 g


Control group

  • Calcium (370 mg) and oxalate (38 mg) diet


Pharmacological co-intervention with hydrochlorothiazide (50 µg/12 h) + potassium citrate (5 mEq/8 h) in both groups


Outcomes
  • Reduction in 24 h urine calciuria and oxaluria


Notes
  • Drop-outs: NS


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskRandomisation method not described

Allocation concealment (selection bias)Unclear riskAllocation method unspecified

Blinding (performance bias and detection bias)
All outcomes
High riskDue to the nature of the intervention, patients and researchers were not blinded

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskDrop-outs not specified

Selective reporting (reporting bias)Low riskApparently free of selective outcome reporting

Other biasHigh riskPharmacological co-intervention with hydrochlorothiazide (50 µg/12 h) + potassium citrate (5 mEq/8 h) in both groups

Nishiura 2004

Methods
  • Study design: parallel RCT
  • Time frame: NS
  • Study duration: 3 months


Participants
  • Setting: Single centre
  • Country: Brazil
  • Patients with at least one kidney stone
  • Number: treatment group (33); control group (36)
  • Mean age ± SD (years): treatment group (39 ± 9); control group (37 ± 8)
  • Sex (M/F): treatment group (17/16); control group (22/14)
  • Exclusion criteria: patients with diseases that might have led to secondary calcium stones, such as primary hyperparathyroidism, distal renal tubular acidosis, UTIs, primary hyperoxaluria


InterventionsTreatment group

  • Phyllanthus niruri capsules: 450 mg, 3 times/d


Control group

  • Chicorium sativum capsules: 450 mg, 3 times/d


Co-interventions: NS


Outcomes
  • Reduction in calciuria (24 h urine calciuria or calcium/creatinine ratio)


Notes
  • Dropouts: NS


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskRandomisation method unspecified

Allocation concealment (selection bias)Unclear riskAllocation method unspecified

Blinding (performance bias and detection bias)
All outcomes
Low riskP. niruri and placebo capsules were manufactured in the same way

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskDropouts not reported

Selective reporting (reporting bias)Low riskApparently free of selective outcome reporting

Other biasUnclear riskPossible differences in co-intervention between groups not excluded

Nouvenne 2010

Methods
  • Study design: parallel RCT, stratified according to sex
  • Time frame: January 2005 to December 2007
  • Study duration: 3 months


Participants
  • Setting:
  • Country: Italy
  • Patients with hypercalciuria, with at least one oxalate calcium stone excretion episode
  • Number: treatment group (108); control group (102)
  • Mean age ± SD (years): treatment group (39 ± 9); control group (40 ± 10)
  • Sex (M/F): treatment group (78/30); control group (72/30)
  • Exclusion criteria: primary hyperparathyroidism, primary hyperoxaluria, enteric hyperoxaluria, bowel resection, inflammatory bowel disease, renal tubular acidosis, sarcoidosis, sponge kidney, and hyperthyroidism; chronic use of drugs capable of increasing the risk of calcium stone formation, such as vitamin D, acetazolamide, and antiepileptic drugs


InterventionsTreatment group

  • Low salt diet: no salt used in cooking or added to foods
  • Water: 2 to 3 L/d
  • Calcium: normal levels (800 to 100 mg/d)


Control group

  • Water: 2 to 3 L/d


Outcomes
  • Reduction in 24 h urine calciuria and oxaluria


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer-generated 2 sequences of random treatment assignments. Randomisation was stratified according to sex

Allocation concealment (selection bias)Low riskTreatment assignment was concealed from the doctor and the patient by using 2 series of sealed, progressively numbered envelopes for men and women

Blinding (performance bias and detection bias)
All outcomes
High riskDue to the nature of the intervention, patients and researchers were not blinded

Incomplete outcome data (attrition bias)
All outcomes
High risk13 participants did not complete the study: 2 patients in Group A (due to work problems to assist visits) and 11 patients in Group B (due to adaptation problems to low salt diet)

Selective reporting (reporting bias)Low riskApparently free of selective outcome reporting

Other biasHigh riskStudy findings applicable only to patients used to high salt diets (averaging up to 13 g/d)

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Ala-Opas 1987Wrong intervention: patients treated with thiazides

Aras 2008Wrong population: study performed in patients with hypocitraturia

Baxmann 2003Wrong population: no patients with hypercalciuria included

Bellizzi 1999Wrong population: no patients with hypercalciuria included

Borghi 1996No data analysis of hypercalciuria group participants

Campoy Martinez 1994No data analysis of hypercalciuria group participants

Colette 1993Not RCT

Domrongkitchaiporn 2004Wrong population: no patients with hypercalciuria included

Hiatt 1996No data analysis of hypercalciuria group participants. Patients had histories of recurrent calcium oxalate kidney stones. RCT evaluated effects of low animal protein/high fibre diet plus fluid and calcium intake recommendations versus fluid and calcium intake recommendations alone

Jaeger 1982Not RCT

Karagulle 2007No data analysis of hypercalciuria group participants

Kocvara 1999No data analysis of hypercalciuria group participants

Lamid 1984Wrong population: study performed in spinal cord injury patients

Matsumoto 2006Wrong population: no patients with hypercalciuria

Muller 2001Not RCT

Rotily 2000No data analysis of hypercalciuria group participants

Schwille 1997Not RCT

van Faassen 1998Data not provided on each group at the end of the intervention; intra-group differences reported from baseline only

 
Comparison 1. Low calcium diet versus normal calcium, low protein, low salt diet

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 No new recurrences of kidney stones1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 2 Urinary calcium levels1Mean Difference (IV, Random, 95% CI)Totals not selected

 3 Urinary oxalate levels1Mean Difference (IV, Random, 95% CI)Totals not selected

 4 Calcium oxalate relative supersaturation index1Mean Difference (IV, Random, 95% CI)Totals not selected

 5 Changes in blood pressure1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 2. Low salt, normal calcium diet versus normal salt diet

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Urinary calcium levels1Mean Difference (IV, Random, 95% CI)Totals not selected

 2 Urinary oxalate levels1Mean Difference (IV, Random, 95% CI)Totals not selected

 
Comparison 3. Phyllanthus niruri versus placebo

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Urinary calcium levels1Mean Difference (IV, Random, 95% CI)Totals not selected

 
Comparison 4. Unprocessed wheat bran

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Urinary calcium levels1Mean Difference (IV, Random, 95% CI)Totals not selected

 2 Urinary oxalate levels1Mean Difference (IV, Random, 95% CI)Totals not selected