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Intervenciones médicas y alimentarias para la prevención de los cálculos urinarios recurrentes en niños

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References

References to studies included in this review

Sarica 2006 {published data only}

Sarica K, Erturhan S, Yurtseven C, Yagci F. Effect of potassium citrate therapy on stone recurrence and regrowth after extracorporeal shockwave lithotripsy in children. Journal of Endourology / Endourological Society 2006;20(11):875‐9. CENTRAL

References to studies excluded from this review

Choi 2011 {published data only}

Choi JN, Lee JS, Shin JI. Low‐dose thiazide diuretics in children with idiopathic renal hypercalciuria. Acta Paediatrica 2011;100(8):71‐4. CENTRAL

Gheissari 2012 {published data only}

Gheissari A, Ziaee A, Farhang F, Farhang F, Talaei Z, Merrikhi A, et al. Evaluating the effectiveness of adding magnesium chloride to conventional protocol of citrate alkali therapy in children with urolithiasis. International Journal of Preventive Medicine 2012;3(11):791‐7. CENTRAL

IRCT2014041217234N1 {unpublished data only}

IRCT2014041217234N1. Comparing effectiveness of combination of magnesium oxide and potassium citrate with potassium citrate in children with urolithiasis. www.irct.ir/searchresult.php?keyword=&id=17234&number=1&prt=6562&total=10&m=1 Date first received: 22 December 2014. CENTRAL

Naseri 2011 {published data only}

Naseri M, Sadeghi R. Role of high‐dose hydrochlorothiazide in idiopathic hypercalciuric urolithiasis of childhood. Iranian Journal of Kidney Diseases 2011;5(3):162‐8. CENTRAL

NCT00120731 {unpublished data only}

NCT00120731. Effects of potassium citrate in urine of children with elevated calcium in urine and kidney stones. clinicaltrials.gov/ct2/show/study/NCT00120731 Date first received: 19 July 2005. CENTRAL

NCT02289755 {unpublished data only}

NCT02289755. Evaluating ALLN‐177 for reducing urinary oxalate excretion in calcium oxalate kidney stone formers with hyperoxaluria. clinicaltrials.gov/ct2/show/study/NCT02289755 Date first received: 13 November 2014. CENTRAL

Ogûz 2013 {published data only}

Ogûz U, Unsal A. The efficacy of medical prophylaxis in children with calcium oxalate urolithiasis after percutaneous nephrolithotomy. Journal of Endourology / Endourological Society 2013;27(1):92‐5. CENTRAL

Tekin 2002 {published data only}

Tekin A, Tekgul S, Atsu N, Bakkaloglu M, Kendi S. Oral potassium citrate treatment for idiopathic hypocitruria in children with calcium urolithiasis. Journal of Urology 2002;168(6):2572‐4. CENTRAL

Yousefichaijan 2015 {published data only}

Yousefichaijan P, Cyrus A, Dorreh F, Rafeie M, Sharafkhah M, Frohar F, et al. Oral zinc sulfate as adjuvant treatment in children with nephrolithiasis: a randomized, double‐blind, placebo‐controlled clinical trial. Iranian Journal of Pediatrics 2015;25(6):e1445. CENTRAL

Additional references

Arrabal‐Polo 2013

Arrabal‐Polo MA, Arrabal‐Martin M, Arias‐Santiago S, Garrido‐Gomez J, Poyatos‐Andujar A, Zuluaga‐Gomez A. Importance of citrate and the calcium: citrate ratio in patients with calcium renal lithiasis and severe lithogenesis. BJU International 2013;111(4):622‐7. [MEDLINE: 22757744]

Borghi 1996

Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5‐year randomized prospective study. Journal of Urology 1996;155(3):839‐43. [MEDLINE: 8583588]

Bush 2010

Bush NC, Xu L, Brown BJ, Holzer MS, Gingrich B, Schuler B, et al. Hospitalizations for pediatric stone disease in United States, 2002‐2007. Journal of Urology 2010;183(3):1151‐6.

Dussol 2008

Dussol B, Iovanna C, Rotily M, Morange S, Leonetti F, Dupuy P, et al. A randomized trial of low‐animal‐protein or high‐fiber diets for secondary prevention of calcium nephrolithiasis. Nephron Clinical Practice 2008;110(3):c185‐94. [PUBMED: 18957869]

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Fink 2013

Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R, Rutks IR, et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Annals of Internal Medicine 2013;158(7):535‐43. [MEDLINE: 23546565]

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Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease. Advances in Chronic Kidney Disease 2013;20(2):165‐74. [MEDLINE: 23439376]

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Higgins 2011b

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Kocvara R, Plasgura P, Petrik A, Louzensky G, Bartonickova K, Dvoracek J. A prospective study of nonmedical prophylaxis after a first kidney stone. BJU International 1999;84(4):393‐8. [MEDLINE: 10468751]

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Malek RS, Kelalis PP. Pediatric nephrolithiasis. Journal of Urology 1975;113(4):545‐51. [MEDLINE: 1117531]

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Nimkin K, Lebowitz RL, Share JC, Teele RL. Urolithiasis in a children's hospital: 1985‐1990. Urologic Radiology 1992;14(3):139‐43. [MEDLINE: 1290199]

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Jump to:

Sarica 2006

Methods

Design: randomized trial.

Setting/country: single center/Turkey.

Dates when study was conducted: not reported.

Participants

Inclusion criteria: children with calcium‐containing idiopathic nephrolithiasis and normal renal morphology following initial treatment with shockwave lithotripsy.

Exclusion criteria: children with anatomic abnormalities, previous stone surgery or urinary tract infection, renal tubular acidosis, renal functional disorders, cystinuria or any other evident metabolic abnormality (primary or secondary hyperoxaluria, hyperparathyroidism, etc.).

Total number of participants randomly assigned: 125 (58 boys, 38 girls).

Experimental group:

  • number of participants randomly assigned: unclear; data reported on 48

  • mean age (years): 6.9 (range: 4‐12);

  • mean size of stone before shockwave lithotripsy (mm): 9.4 (range: 7.9‐15.8).

Control group:

  • number of participants randomly assigned: unclear; data reported on 48

  • mean age (years): 7.4 (range: 4‐14);

  • mean size of stone before shockwave lithotripsy (mm): 8.9 (range: 8.5‐14.6).

Interventions

Experimental group:

  • oral potassium citrate 1 mEq/kg per day for 12 months.

Control group:

  • no specific medication or preventive measure.

Follow‐up (mean): 24.4 months.

Outcomes

  • True new stone recurrence.

  • Stone regrowth.

  • Risk factors for stone recurrence and regrowth.

Notes

Funding source and conflicts of interests: not reported.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomization method unspecified.

Allocation concealment (selection bias)

Unclear risk

Allocation concealment method unspecified.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants and researchers not blinded.

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Participants and researchers not blinded.

Incomplete outcome data (attrition bias)
Objective outcomes

High risk

High (23%) attrition rate in study cohort.

Selective reporting (reporting bias)

Unclear risk

No protocol available for review; therefore, risk of bias from selective reporting was unclear.

Other bias

Low risk

Apparently free of other problems that could put it at a risk of bias.

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Choi 2011

Wrong population (not all children included in the cohort had a primary stone event).

Gheissari 2012

Wrong study design (non‐randomized).

IRCT2014041217234N1

Wrong population (children with small stone, not recurrent).

Naseri 2011

Wrong intervention (duration of intervention < 12 months).

NCT00120731

Wrong study design (single arm).

NCT02289755

Wrong study design (single arm).

Ogûz 2013

Wrong study design (non‐randomized retrospective).

Tekin 2002

Wrong study design (non‐randomized).

Yousefichaijan 2015

Wrong intervention (duration of intervention < 12 months).

Data and analyses

Open in table viewer
Comparison 1. Potassium citrate versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone recurrence and regrowth Show forest plot

1

96

Risk Ratio (M‐H, Random, 95% CI)

0.19 [0.06, 0.60]

Analysis 1.1

Comparison 1 Potassium citrate versus no treatment, Outcome 1 Stone recurrence and regrowth.

Comparison 1 Potassium citrate versus no treatment, Outcome 1 Stone recurrence and regrowth.

2 Adverse events Show forest plot

1

96

Risk Ratio (M‐H, Random, 95% CI)

13.00 [0.75, 224.53]

Analysis 1.2

Comparison 1 Potassium citrate versus no treatment, Outcome 2 Adverse events.

Comparison 1 Potassium citrate versus no treatment, Outcome 2 Adverse events.

Risk of bias summary: review authors' judgments about each risk of bias item for each included study (single study).
Figures and Tables -
Figure 1

Risk of bias summary: review authors' judgments about each risk of bias item for each included study (single study).

Study flow diagram.
Figures and Tables -
Figure 2

Study flow diagram.

Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies (single study).
Figures and Tables -
Figure 3

Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies (single study).

Comparison 1 Potassium citrate versus no treatment, Outcome 1 Stone recurrence and regrowth.
Figures and Tables -
Analysis 1.1

Comparison 1 Potassium citrate versus no treatment, Outcome 1 Stone recurrence and regrowth.

Comparison 1 Potassium citrate versus no treatment, Outcome 2 Adverse events.
Figures and Tables -
Analysis 1.2

Comparison 1 Potassium citrate versus no treatment, Outcome 2 Adverse events.

Summary of findings for the main comparison. Potassium citrate compared to no intervention for preventing urinary stones in children

Patient or population: children with idiopathic urinary calculi treated with shockwave lithotripsy
Setting: likely outpatient
Intervention: potassium citrate
Comparison: no intervention

Outcomes

No of participants
(studies)

Quality of the evidence
(GRADE)

Relative effect
(95% CI)

Anticipated absolute effects* (95% CI)

Risk with no intervention

Risk difference with medical or dietary interventions

Proportion of participants who developed a new urinary stone
follow‐up: mean 24.4 months

96
(1 RCT)

⊕⊕⊝⊝
Low1

RR 0.19
(0.06 to 0.60)

Study population

333 per 1000

270 fewer per 1000
(133 fewer to 313 fewer)

Proportion of participants with adverse events while undergoing intervention

follow‐up: mean 24.4 months

96
(1 RCT)

⊕⊝⊝⊝
Very low1,2,3

RR 13.00
(0.75 to 224.53)

Study population

Proportion of participants undergoing retreatment for urinary stones

no information found

NA

NA

NA

NA

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomized controlled trial; RR: risk ratio; NA: not applicable (since no information found).

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Downgraded by two levels for study limitations: almost all domains were unclear or high risk of bias.

2Downgraded by two levels for imprecision: very rare event resulting in very wide confidence interval.

3No event in control arm.

Figures and Tables -
Summary of findings for the main comparison. Potassium citrate compared to no intervention for preventing urinary stones in children
Comparison 1. Potassium citrate versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone recurrence and regrowth Show forest plot

1

96

Risk Ratio (M‐H, Random, 95% CI)

0.19 [0.06, 0.60]

2 Adverse events Show forest plot

1

96

Risk Ratio (M‐H, Random, 95% CI)

13.00 [0.75, 224.53]

Figures and Tables -
Comparison 1. Potassium citrate versus no treatment