It’s widely believed that drinking more water can prevent kidney stones. Kidney stones are solid, crystallized mineral deposits that form in the urinary tract when substances like calcium, oxalate, or uric acid become highly concentrated. Symptoms can include severe side or back pain, nausea, and blood in the urine.
Kidney stones are not only painful to deal with, but treatment can be costly, with prices ranging from $10,000 to $12,000 without insurance. Plus, the chances of recurrence are high, with about 30 to 50 percent of people developing another kidney stone within five to seven years.
A new study challenges the long-standing recommendation to drink more water to reduce the recurrence of kidney stones.
But what does this mean for patients — particularly Black adults who already face disparities in kidney health?
For patients with a history of urinary stone disease, a behavioral intervention to promote fluid intake does not reduce recurrent stone events, according to a study published in the March 21 issue of The Lancet.
Alana C. Desai, M.D., from Washington University in St. Louis, and colleagues examined whether a multicomponent behavioral intervention program to promote high fluid intake reduces symptomatic stone recurrence. Participants aged 12 years and older with a history of urinary stone disease and low 24-hour urine volumes were randomly assigned to an intervention group or a control group, which received guideline-concordant care (826 and 832 patients, respectively).
Overall, 66.6 percent of the participants were recurrent stone formers. The researchers found that symptomatic stone events occurred in 19 percent and 20 percent of patients in the intervention and control groups, respectively, at a median follow-up of 738 days. In both groups, 24-hour urine volume increased from baseline and was higher in the intervention group than the control group at six, 12, 18, and 24 months. At six and 12 months, the intervention group had greater urinary storage symptoms of frequency, urgency, and nocturia compared with the control group. From baseline to end-of-study imaging, no difference was seen in stone growth of at least 2 mm or new stones between the groups; no significant between-group difference was seen in the composite outcome of symptomatic stone recurrence, new stone formation, or stone growth of at least 2 mm.
“Rather than asking every patient to meet the same fluid goal, we should determine who benefits from which targets, understand why adherence breaks down, and build interventions — behavioral and medical — that reliably reduce stone recurrence,” co-senior author Gregory E. Tasian, M.D., from the Children’s Hospital of Philadelphia, said in a statement.
Several authors disclosed ties to the pharmaceutical industry.
The study does not completely disregard the role of hydration in the management of kidney stones. However, researchers note that hydration alone may not be sufficient — especially without addressing underlying metabolic or dietary factors.
When treating kidney stones, an individualized care plan can be more effective than a one-size-fits-all approach. Depending on the stone’s size, common treatment recommendations include pain medications, medical alpha-blockers, and increased hydration. Surgical procedures may be recommended for larger stones.
Despite the many treatments available to manage kidney stones, there can be some challenges. Some patients may have difficulty adhering to treatment, with research showing that only about 50 percent follow prescribed therapies and lifestyle changes.
The study’s researchers noted that recurrent kidney stones can significantly impact quality of life, with patients having to use the bathroom more frequently and urgently, and experiencing nocturia (waking up one or more times during the night to urinate).
While kidney stones have been historically reported more in white populations, trends are shifting. Diagnoses among Black patients have risen significantly in recent years, increasing by approximately 15 percent every five years. In addition, Black patients are less likely to receive adequate pain management or undergo surgical removal of the stone compared to other racial/ethnic groups.
Several structural barriers can keep us from receiving the proper care for kidney stones, including inadequate access to preventive care and delayed diagnosis or treatment. These disparities underscore the importance of more personalized preventive strategies for the Black community.
While drinking water is helpful, it is only one piece of the puzzle. Preventing the recurrence of kidney stones can require multiple strategies, including dietary changes, lifestyle changes, and medical care.
If you have recurring kidney stones, it’s best to consult your healthcare provider for personalized advice on preventing them from returning.
Hydration is great, but it is not a cure-all for recurring kidney stones. Treatment requires a personalized approach recommended by your healthcare provider. As the research continues to evolve, kidney stone prevention is moving beyond simple advice toward more personalized strategies.
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