Urinary Composition and Lithogenic Risk in Normal Subjects following Oligomineral versus Bicarbonate-Alkaline High Calcium Mineral Water Intake

Abstract

Objective: A normal dietary calcium intake to reduce intestinal oxalate absorption is essential to avoid recurrence of calcium oxalate stone formation. It is also important in the prevention of osteopenia in idiopathic hypercalciuria. The calcium content of waters used for hydration may vary from very low to relatively high and is an important factor in prevention or additional risk of stone formation. Therefore, the effect of drinking mineral waters of different calcium concentrations on lithogenic risk factors was studied in normal volunteers. Materials and Methods: Normal subjects were divided into two groups of 11 and 10 individuals each. All followed a prescribed diet with an average calcium content of 800 mg/day. The water intake for hydration consisted of 2 liters of an oligomineral water with a low calcium content, <20 mg/l (group A) or of a bicarbonate alkaline water with a high calcium content, 370 mg/l (group B). Results: Diuresis increased similarly in both groups; urine calcium increased by about 80 mg/day in group B. A rise in urine oxalate was observed in both groups, along with the increased urine volume. Osmolar excretion increased in group B; urine osmolality decreased significantly only in group A. In spite of the increase in calciuria in group B, Ca/citrate ratio was constant, due to an increase in citrate excretion. Inter-group differences in terms of activity products of calcium phosphate, calculated according with Tiselius’s methods, were found. The differences in AP(CaP) index 1 and AP(CaP) index 2 were significant, with higher values in group B, who drank the bicarbonate alkaline mineral water. Conclusions: Increased water intake between meals to prevent renal stone recurrence should preferably be achieved with a relatively low calcium water and calcium-rich mineral waters should be avoided.

Influence of a mineral water rich in calcium, magnesium and bicarbonate on urine composition and the risk of calcium oxalate crystallization

“…No relation was established between urinary sodium and calcium excretion, neither on standardized nor on normal dietary conditions. The majority of the studies evaluating the effect of the calcium content of water on urine composition revealed significant increases in urinary calcium excretion both in normal subjects (Rodgers, 1997;Coen et al, 2001) and stone formers (Ackermann et al, 1988;Marangella et al, 1996;Rodgers, 1997;Caudarella et al, 1998) on a high as opposed to a low calcium load with water.…”

Human health risk assessment of temporal and spatial variations of ground water quality at a densely industrialized commercial complex at Haridwar, India

“…Bicarbonate ingestion causes changes in acid-base balance, blood pH and bicarbonate concentration in biological fluids. Coen et al (2001) suggested that consumption of bicarbonate-rich water lowers the risk of calculus formation in urine. In contrast, Lutai (1992) reported higher incidence of goiter, hypertension, ischemic heart disease, gastric and duodenal ulcers, chronic gastritis, cholecystitis and nephritis due to consumption of mineral deficient water.…”

Ion specificity in determining physico-chemical properties of drinking water

“…Most of the studies focus on the total quantity of dissolved electrolyte in drinking water (Bellizzi et al, 1999;Chatterjee et al, 2012) or, more specifically, on the effects of distinct electrolytes (Panhwar et al, 2013;Siener et al, 2004). Despite the researchers efforts, the effect of water hardness on nephrolithiasis remains unclear (Schwartz et al, 2002;Coen et al, 2001;Rodgers, 1997); on the other hand, it is now generally accepted that bicarbonate-rich water have a positive effect (Karagülle et al, 2007;Bertaccini & Borghesi, 2009), probably due to increased pH which increases solubility of uric acid and urinary citrate concentration, with inhibition of calcium crystal formation and aggregation. The presence of other solutes, such as humous (humic and fulvic) acids, has also been analyzed and connected with the degradation of stones in the urinary tract (Davydova et al, 2014).…”