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Hydration strategy test for kidney stones is in water: Study

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A large new clinical trial has taken a closer look at a long-standing piece of medical advice for kidney stone patients: drink more water. While the recommendation remains sound, the study suggests that actually sticking to it in real life is far harder than many assume.

Kidney stones are known for causing severe, often debilitating pain. In the United States, about one in 11 people will develop them at some point, and nearly half of those patients are likely to face a recurrence. Preventing that cycle has been a major focus for doctors, with high fluid intake widely seen as one of the most effective strategies.

To test how practical that advice is, researchers from the Urinary Stone Disease Research Network conducted what is now the largest behavioural study of its kind. The trial, coordinated by the Duke Clinical Research Institute and published in The Lancet on March 19, followed 1,658 adolescents and adults across six major U.S. medical centres over a two-year period.

Participants were split into two groups. One received standard care, while the other was enrolled in an intensive hydration programme designed to encourage higher fluid intake. This programme went beyond simple advice. It included smart water bottles that tracked how much participants drank, personalised daily hydration targets, reminder messages, financial incentives, and regular health coaching.

Each participant in the programme was given a tailored “fluid prescription,” calculated based on how much urine they typically produced and how much more fluid they would need to reach a target of at least 2.5 litres per day — a level believed to reduce the risk of stone formation.

The results showed that people in the programme did increase their fluid intake and produced more urine on average. However, the improvement was modest, and crucially, it did not translate into a significant reduction in the recurrence of symptomatic kidney stones across the group as a whole.

Researchers say this gap highlights a central challenge: adherence. Even with constant reminders, monitoring, and incentives, maintaining very high levels of daily fluid intake proved difficult.

Charles Scales, a senior author of the study and a professor at Duke University School of Medicine, noted that the findings underline how demanding such lifestyle changes can be. He pointed out that difficulty in maintaining these habits likely contributes to the high rate of recurrence seen in kidney stone patients.

Importantly, the study stands out for measuring actual stone recurrence rather than relying only on indirect markers such as fluid intake or urine output. Researchers used imaging and regular follow-ups to track whether new stones formed or existing ones grew, offering a more realistic picture of outcomes.

The findings are prompting experts to rethink a one-size-fits-all approach. Gregory Tasian, a co-senior author and paediatric urologist, said future strategies may need to be more personalised. Instead of asking every patient to meet the same hydration target, doctors may need to identify which patients benefit most from specific goals and why others struggle to maintain them.

The study also points to broader factors that may affect hydration habits — including work environments, daily routines, and individual health conditions — suggesting that behavioural solutions alone may not be enough.

Researchers are now calling for more tailored interventions, which could include customised hydration plans, better ways to address practical barriers to drinking more fluids, and even medical therapies aimed at preventing minerals from crystallising in urine.

For patients, the takeaway is clear but nuanced. Drinking more water still matters, but this study shows that turning that advice into a sustainable daily habit — and one that meaningfully reduces risk — is more complex than it appears.

As lead author Alana Desai put it, kidney stone disease is a chronic condition marked by sudden and often severe episodes that can disrupt everyday life. While many patients would welcome a simple solution, the path to prevention may require a more personalised and multifaceted approach.

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Diets rich in these minerals may help prevent recurrent kidney stones

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Kidney stones can cause not only excruciating pain but also are associated with chronic kidney disease, osteoporosis and cardiovascular disease. If you’ve experienced a kidney stone once, you have a 30% chance of having another kidney stone within five years.

Changes in diet are often prescribed to prevent recurrent symptomatic kidney stones. However, little research is available regarding dietary changes for those who have one incident of kidney stone formation versus those who have recurrent incidents.

Mayo Clinic researchers designed a prospective study to investigate the impact of dietary changes. Their findings show that enriching diets with foods high in calcium and potassium may prevent recurrent symptomatic kidney stones.

Dietary factors were based on a questionnaire administered to 411 patients who had experienced first-time symptomatic kidney stones and a control group of 384 people — all of whom were seen at Mayo Clinic in Rochester and Mayo Clinic in Florida between 2009 and 2018. The findings, which were published in Mayo Clinic Proceedings, show that lower dietary calcium and potassium, as well as lower intake of fluids, caffeine and phytate, are associated with higher odds of experiencing a first-time symptomatic kidney stone.

Of the patients who had first-time stone formation, 73 experienced recurrent stones within a median of 4.1 years of follow-up. Further analysis found that lower levels of dietary calcium and potassium predicted recurrence.

“These dietary findings may have particular importance because recommendations for preventing kidney stones have been based primarily on dietary factors associated with first-time rather than recurrent stone formation,” says Andrew Rule, M.D., a Mayo Clinic nephrologist and senior author of the study. “Patients may not be likely to adjust their diet to prevent an incidence of kidney stones, but they are more likely to do so if it can help prevent recurrence.”

Fluid intake of less than 3,400 milliliters per day, or about nine 12-ounce glasses, is associated with first-time stone formation, along with caffeine intake and phytate, the study finds. Daily fluid intake includes intake from foods such as fruits and vegetables.

Low fluid and caffeine intake can result in low urine volume and increased urine concentration, contributing to stone formation. Phytate is an antioxidant compound found in whole grains, nuts and other foods that can lead to increased calcium absorption and urinary calcium excretion.

“Changing your diet to prevent kidney stones can be very difficult,” says Dr. Rule. “Thus, knowing the dietary factors that are most important for preventing kidney stone recurrence can help patients and providers know what to prioritize.”

Low dietary calcium and potassium was a more important predictor than fluid intake of recurrent kidney stone formation, says Api Chewcharat, M.D., the article’s first author and a postdoctoral research fellow at Mayo Clinic at the time of the study. “This is not to say high fluid intake is not important. We just did not find benefits of increasing fluid intake among those patients with a history of kidney stone formation.”

The study concludes that diets with daily intake of 1,200 milligrams of calcium may help prevent first-time and recurrent kidney stones. That daily intake is in line with the Department of Agriculture’s daily recommended nutrition.

While higher potassium intake also is recommended, the USDA does not make a recommendation for daily potassium intake. The study also doesn’t recommend an intake level.

Dr. Chewcharat says the takeaway is that patients should add more fruits and vegetables that are high in calcium and potassium to their diets. Fruits that are high in potassium include bananas, oranges, grapefruits, cantaloupes, honeydew melons and apricots. Vegetables include potatoes, mushrooms, peas, cucumbers and zucchini.