How can I advise patients on dietary modifications to prevent recurrence of kidney stones?

Advise patients on the following dietary modifications to prevent recurrence of kidney stones:

• Encourage a high fluid intake: adults should drink 2.5 to 3 litres of water daily, and children 1 to 2 litres depending on age, to reduce stone formation risk.
• Recommend adding fresh lemon juice to drinking water, as citrate in lemon juice can inhibit stone formation by increasing urinary citrate levels.
• Advise avoiding carbonated drinks, which have been associated with increased stone recurrence.
• Suggest maintaining a normal calcium intake (700 to 1,200 mg daily for adults; 350 to 1,000 mg for children depending on age) rather than restricting calcium, as normal calcium intake may help prevent stones.
• Recommend limiting salt intake to no more than 6 g per day for adults (2 to 6 g for children depending on age) to reduce urinary calcium excretion and stone risk.
• Advise avoiding a high protein diet, although evidence is inconclusive, this is commonly recommended.

These dietary and lifestyle recommendations should be part of a balanced diet including plenty of fruits and vegetables and maintaining a healthy weight.

For patients with recurrent calcium oxalate stones and specific metabolic abnormalities, pharmacological treatments such as potassium citrate or thiazides may be considered, usually initiated in secondary care.

Written patient information is also recommended to support understanding and adherence.

References: ¹,²,³