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InstitutBMKEffect of a bicabonate-rich mineral water in patients
with recurrent renal stone formation a controlled double-blind
study
Chr. Gutenbrunner, U. Smorag, O. Karaglle, F. Candir, H. Becker,
U. Jonas
Professor Christoph Gutenbrunner, MD, PhD,Clinic for Physical
Medicine and RehabilitationHanover Medical SchoolCarl-Neuberg-Str.
1 D-30625 [email protected]
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKIntroduction In the industrialised countries
urolithiasis is a frequent disease Prevalence in Germany: 4.7%
Incidence: 1.47% The rate of relapses is high: 50-60% The
extra-corporal shock-wave therapy is not free of complications For
that reason an effective metaphylaxis is of major importance
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKIntroduction A basic principle of the metaphylaxis of
urolitioasis is the dilution of the urine by an increase of the
fluid intake Additional principles are the reduction of the
excretion of stone forming substances in the urine: calcium,
oxalate, uric acid and others the enhancement of the excretion of
inhibitors: magnesium, citrate and others the reduction of the
crystallisation risk by influencing the pH of the urine (dependent
on the type of renal stones)
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKIntroduction From experimental studies it is known
that bicarbonate waters increase the urinary pH and the citrate
excretion magnesium-rich waters increase the urinary excretion of
magnesium the increase of calcium-excretion is over- compensated by
the increase of diuresis Only a few studies were performed in
patients Most studies dealt with the problem of calcium-waters
Therefore we studied the effect of a magnesium- and
bicarbonate-rich mineral water
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKMaterial and Methods Design of the Study:-
double-blind controlled study- cross-over-design Patients:-
Patients with multi-episodic CaOx-urolithiasis (n=34)-
males/females: 30/4- number of stone episodes: 3.0 1.6 Setting:-
Everyday activities- no standardisation of the diet- nutrition
protocol
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKMaterial and Methods Interventions:- 1.5 l/d
bicarbonated water (2,673 mg HCO3-/l; 175 mg Mg++/l; 116 mg
Ca++/l)- 1.5 l/d low-mineralized water (98 mg HCO3-/l8 mg Mg++/l;
38 mg Ca++/l)- 1.400 ml of each water for three consecutive days-
all waters in the same type of bottles, colour code- distance
between drinking periods: one week Main Outcome Parameters: -
24-h-urine samples before drinking, 3rd day of drinking- urinary pH
(24-h-urine)- magnesium- and citrate-excretion- supersaturation
CaOx and of other types of urinary stones
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKResults
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKResults
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKResults
Supersaturation CaOxSupersaturation Uric acidSupersaturation
CaPO4ControlsBaseline3,41 0,311,22 0,131,33 0,19Drinking2,44
0,280,70 0,071,01 0,15Bicarbonate WaterBaseline3,39 0,341,03
0,121,44 0,23Drinking2,42 0,290,24 0,042,01 0,24p (controls vs.
bicarbonate water)*)0,8010,0010,001p (baseline vs. Drinking)**)
Controls0,0010,0010,014Bicarbonate Water0,0010,0010,023
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKPatients with high riskp1 = Significance between
verum and controls p2 = Significance between baseline and drinking
period
Low mineralised water bicarbonate rich waterBaselineIntervention
BaselineIntervention SignificanceCitrate-concentration (mmol/l)1,73
0,881,18 0,431,61 0,721,60 0,56p1 = 0,016**p2 = 0,001***p2 =
0,884Magnesium-concentration (mmol/l)2,18 0,921,53 0,492,09
0,881,99 065p1 = 0,033*p2 = 0,001***p2 = 0,961Calcium-concentration
(mmol/l)3,15 1,682,17 1,083,07 1,372,57 1,27p1 =
0,245p2=0,001***p2=0,007**Oxalate-concentration (mmol/l)0,29
0,090,21 0,100,28 0,120,21 0,09p1 = 0,879p2 = 0,002**p2 =
0,001***Uric acid-concentration (mmol/l)1,77 0,671,21 0,321,49
0,371,36 0,40p1 = 0,152p2 = 0,001***p2 =
0,140Phosphate-concentration (mmol/l)15,79 6,4810,86 3,2916,12
3,299,80 3,42p1 = 0,231p2 = 0,001***p2 = 0,001***
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund
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InstitutBMKConclusion Both waters significantly reduce the renal
stone formation risk in patients with relapsing CaOx-urolithiasis
The mineral water additionally increases the urinary pH as well as
the excretion of magnesium and citrate The mineral water is
effective even in cases with high risk of stone formation
(hypercalciuria, hyperoxaluria) Bicarbonated waters should be used
in patients with combined stones containing CaOx and uric acid or
in uric acid stones but not in in patients with phosphate
stones
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Medizinische Hochschule Hannover
Institut Balneologie Medizinische Klimatologie
frund