Predictive Factors for Achieving the Recommended AUA Daily Urine Production in Patients With Nephrolithiasis

• Main Authors: Kimberly Tay, MD, Anojan Navaratnam, MBBS, FRACS, Sean McAdams, MD, Mira Keddis, MD, Matthew Neville, MS, Mitchell R. Humphreys, MD
• Format: Article
• Language: English
• Published: Elsevier 2019-06-01
• Series: Mayo Clinic Proceedings: Innovations, Quality & Outcomes
• Online Access: http://www.sciencedirect.com/science/article/pii/S2542454819300359

Objective: To identify factors that predict kidney stone patient's ability to produce 2.5 L urine volume per day on metabolic evaluation. Patients and Methods: In a retrospective chart review, the first analysis evaluated initial 24-hour urine collections with respect to those who achieved or did not achieve a urine volume of 2.5 L/day. The second analysis evaluated those who achieved or did not achieve a daily urine volume of 2.5 L on their subsequent collection. Several variables were assessed. Results: Patients’ initial collections (n=1100) that achieved 2.5 L/day (n=274) were of younger age and had a higher body mass index, increased urine sodium, phosphorus, calcium levels, increased protein catabolic rate, and decreased supersaturation of calcium oxalate. In the second analysis (n=273), decreased supersaturation of calcium oxalate, increased urine urea nitrogen level, and increased protein catabolic rate were observed in subsequent collections with a urine volume of 2.5 L/day or more. Patients with a diagnosis of hyponatremia were less likely to achieve 2.5 L/day urine volume. Collection date, other comorbidities, and diuretic use were not associated with achieving 2.5 L/day urine volume. Patients’ mean creatinine per kilogram for all study cohorts were within the range of adequate collection. Conclusion: Predictive factors for a urine volume of 2.5 L/day or more include increased fluid intake, higher salt and animal protein diet, elevated body mass index, and male sex. Patients with these factors may require interventions other than hydration recommendations to optimize their prevention of future kidney.