CARI GUIDELINES UPDATED RECOMMENDATIONS FOR THE MANAGEMENT OF KIDNEY STONES
Dr David Tunnicliffe1,2, Prof Andrew Mallett3,4,5, Brydee Cashmore1,2, Dr Adam Mullan6, Lyn Llyod7, Ieuan Wickham8, Dr Hicham Hassan9,10, Prof Matthew Jose11
1Sydney School of Public Health, The University Of Sydney, Sydney, Australia, 2Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 3Department of Renal Medicine, Townsvile University Hospital, Douglas, Australia, 4College of Medicine and Dentistry, James Cook University, Douglas, Australia, 5Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia, 6Northland Renal Services, Te Tai Tokerau, Northland, New Zealand, 7Nutrition and Dietetics, Te Toka Tumai, Auckland, New Zealand, 8Consumer Partner, , , 9Graduate School of Medicine, University of Wollongong,, Wollongong, Australia, 10School of Medicine, Lebanese American University , Beirut, Lebanon, 11School of Medicine, University of Tasmania, Hobart, Australia
Introduction: Recurrent kidney stones have a substantial burden on health systems. Guidelines in Australia and New Zealand are outdated and have had little consumer input. We aim to describe the updated CARI Guidelines recommendations for the management kidney stones.
Methods: A Working Group with expertise in nephrology, renal dietetics and lived experience and a consumer-involvement workshops identified 95 clinical questions to be addressed in the guidelines. We searched MEDLINE for systematic reviews and randomised controlled trials (RCTs) in October 2020 (updated August 2023) to identify relevant studies. Data was synthesised using meta-analysis or narrative synthesis. Recommendations were developed using the Evidence to Decision Framework and certainty of the evidence was rated using GRADE.
Results: We reviewed 5818 systematic reviews and 3510 RCTs. The guidelines recommend the use of ultrasound in the detection of uncomplicated kidney stones to minimise radiation exposure. as well as stone analysis and tailored metabolic evaluation for recurrent kidney stones to inform nutrition and medical management. Nutrition therapy is recommended as first-line treatment with recommendations to optimize fluid intake to achieve a urine output of >2.5 L/day, decreased sodium intake (<2300 mg/d) ,RDI for calcium and centred around a healthy eating pattern. Pharmacological management recommendations include citrate salts (tablets preferred), thiazides to supplement nutrition therapy, and xanthine oxidase inhibitors in recurrent kidney stones with hyperuricosuria. First-line management in acute kidney stone related pain is NSAIDs but rescue pain relief at 30 to 90 mins following administration of therapy should be planned in case it is required.
Conclusions: These guidelines provide a tailored approach to management of kidney stones to prevent kidney stone recurrence in the Australian and New Zealand context.
Biography:
David is a Senior Research Fellow (Level C) at the Sydney School of Public Health, The University of Sydney and recipient of an Australian National Health and Medical Research Council Emerging Leadership 1 Investigator Grant (APP1197337). His research expertise is in the areas of evidence synthesis, living evidence and in eliciting patient priorities for healthcare and research and its application in chronic kidney disease. David is the Scientific Director of the Australian and New Zealand Guideline Developer for kidney disease (CARI Guidelines).