Targeted versus empiric approach for prevention of recurrent kidney stones: Insights on diet therapy from a randomized trial

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• Picked for Urology (top studies of the week, 8 November 2026): Targeted vs empiric diet therapy reduces kidney stone recurrence

Abstract

BACKGROUND: Nephrolithiasis recurs after an initial episode within 5 years for 30-50% of stone formers without dietary and/or pharmacological therapy to prevent or reduce stone recurrence. Preventive interventions target increasing urine volume or altering urinary concentration of key risk factors: high calcium, oxalate or uric acid and low urinary citrate. Two strategies for achieving stone prevention involve an untailored generalized approach (empiric therapy) and an approach tailored to results from 24 h urine testing (selective therapy). METHODS: Adults with recurrent kidney stone disease were randomly assigned to empiric (Emp) or selective (Sel) therapy upon completing 24 h urine testing. Participants in the Emp group received standard guideline-based diet and medication therapy. Participants in the Sel group received therapy tailored to their 3 most severe urine abnormalities. Within-group differences in dietary and urinary variables were assessed via the Wilcoxon test and difference between groups in changes from baseline to 8 weeks via general linear modeling. RESULTS: The Emp group had a 33% reduction in dietary oxalic acid intake (p = 0.02), but no significant changes in intakes of water, sodium, animal-based protein, or servings of fruits and vegetables. There were also no significant changes in urine volume or urinary sodium excretion. Overall, Sel participants increased daily intake of water by 17% (p = 0.02), doubled their number of daily fruit/vegetable servings (p = 0.04), and reduced their oxalate (p = 0.04) and sodium (p = 0.05) intakes. Sel participants in the urinary citrate and calcium subgroups showed greater reductions in urinary calcium oxalate supersaturation (-38%) compared to the Emp group (-30%). CONCLUSIONS: The findings suggest that a more personalized approach with a limited number of dietary targets supports improvements that are less likely to occur with empiric therapy which reflects a "one size fits all" method. However, even with tailored therapy, the inter-individual variability in dietary intake and response to treatment must be considered as adherence to dietary recommendations is particularly challenging in a condition that is lifelong. This trial was registered at clinicaltrials. gov NCT05365477.

Abstract as published, via PubMed.