Medications & Supplements for Kidney Stone Prevention
Dr. David S. Goldfarb
Video Transcript
Hi, I’m Dr. David Goldfarb.
I’m the director of the Kidney Stone Program at NYU Langone
Health in New York.
I’m a professor of Medicine
and Physiology at the NYU Grossman School
of Medicine, and Dr. Josh Stern of the Kidney Stone Collaborative asked me
to talk about medications
and supplements for prevention of recurrent kidney stones.
My conflict of interest is that my partners
and I invented a supplement, a high citrate beverage,
it’s called Stone Stopper, or Moonstone Stone Stopper,
and it is a high citrate beverage.
Citrate gets into the urine, binds to calcium,
and prevents calcium from binding
to oxalate or to phosphate.
Most kidney stones are made of calcium oxalate, some made
of calcium phosphate citrate is an antagonist
of calcium stone formation.
The other benefit of citrate is that it is metabolized
by the kidney and the liver to bicarbonate.
Therefore, that’s a buffer
and it incu increases the pH of the urine.
And a higher urine pH is important
because that can help prevent uric acid stones
and cystine stones.
So citrate is an important supplement.
You can get it without a prescription.
You can buy a stone stopper online.
The medication that you’ll find that claims
to be a citrate supplement in stores like Vitamin Shop
or GNC, is actually a very low dose.
It’s one milli equivalent
and you want doses of more like 10 to 15 milli equivalents,
two or three times a day, citrate’s well tolerated.
It’s very safe and it is an effective treatment
for kidney stones.
You also don’t have to know if
that your 24 hour urine collection shows a low citrate
to take a citrate supplement.
Other products that are available online
are not so effective.
If you look at the ingredients for many of them,
they contain very tiny doses of medications
that are actually effective.
And so for instance, taking vitamin B six, it’s fine.
But it really only helpful for people
who have a rare genetic disease called primary
hyperoxaluria Type one.
It’s just a few thousand people in the United States with
that abnormality.
So vitamin B six is generally not useful.
You do wanna eliminate vitamin C from your
pill collection
because vitamin C is a score date,
it’s metabolized to oxalate.
And the studies are pretty clear
that people taking vitamin C supplementation will have more
oxalate in the urine and a higher rate
of calcium oxalate stones.
Vitamin D of course, is has a little bit of use
may help a little bit in increasing bone density
and reducing osteoporosis fractures.
It’s very hard to get vitamin D toxic to the point
where you develop high calcium in the blood
or urine and kidney stones.
And most sh most studies have not shown
that people taking vitamin D have an increased rate
of kidney stones unless you take gigantic massive
inappropriate doses.
So taking one or 2000 units a day, I think is probably safe,
although its benefit for increasing bone density
is really slight.
The other choice of medications
that has been a little bit controversial this year are the
thiazides thiazides can help lower urine calcium.
They’re often thought of as diuretics,
but when I prescribe it for people with kidney stones,
I’m not using it to increase urine flow.
That’s your job as somebody increasing your water intake.
I’m prescribing thiazides to reduce urine calcium.
That’s a special effect they have on tubular
kidney, reabsorption of calcium.
So if there’s less calcium in the urine,
fewer kidney stones.
A shorter acting thiazide called hydrochlorothiazide.
HCTZ for short was shown last year
to not be very effective in a study
that was done in the New England Journal in Switzerland.
But there are longer acting drugs
that perhaps are more effective like Indapamide
and Chlorthalidone.
They do have some side effects,
particularly loss of potassium.
So my preference is that when people take those thiazides,
they also take a potassium supplement.
Usually potassium citrate is appropriate.
Sometimes potassium chloride is also acceptable.
Those are prescription medications.
The other side effect that they have,
because they’re often used to lower blood pressure,
blood pressure lowering,
might be a good thing if you have high blood pressure
and if you don’t my preference is for indapamide,
which is a little bit less potent
as a blood pressure lowering agent as compared
to chlorthalidone drugs
that are also used
to increase bone density like bisphosphonates have recently
that like your, your best example of that is
alendronate or Fosamax.
And those drugs have recently been shown
to lower urine calcium
because they’re increasing bone density and
therefore prevent kidney stones.
No one’s ever done a study of those drugs specifically
to prevent kidney stones,
but people taking those drugs for bone density do have
fewer fractures and less kidney stones.
Those are the topics that I wanted
to introduce today and I hope that
that’s been useful for you all.
I appreciate your interest
and support in the Kidney Stone Collaboration.