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Does the mineral content of tap water correlate with urinary calculus composition?

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Abstract

The association between the mineral content of drinking water and urolithiasis remains elusive. The aim of this study is to investigate whether the mineral composition of tap water correlates with urinary calculus composition. Patients with calculi that underwent biochemical analysis at two urological centres in the North-West of England between November 2015 and December 2020 were included. Calculus composition was reviewed with respect to patient demographics, serum biochemical variables, and water mineral composition data obtained from the local water supply company using patient postcodes. 1711 urinary tract calculi from 1518 patients, living in 87 water supply zones were included. Water sodium concentration was an independent predictor of mixed calcium oxalate/uric acid calculi (OR 1.157, p < 0.001) and a negative independent predictor of calcium oxalate monohydrate (OR 0.896, p = 0.001) and dihydrate (OR 0.742, p = 0.034) calculi. Moreover, the magnesium-to-calcium ratio of tap water was a negative independent predictor of calcium oxalate monohydrate calculi (OR < 0.001, p =  < 0.001), while tap water magnesium concentration inversely correlated with the percentage of calcium oxalate within calculi (rs = − 0.054, p = 0.026). Total water hardness did not independently predict calculus type. Many factors are implicated in the formation of urinary calculi. This study is the first to assess calculus composition in relation to tap water mineral content using postcode data on a case-by-case basis. Though total water hardness did not independently predict calculus composition, the interesting findings relating to water sodium and magnesium concentrations are in need of closer scrutiny in larger scale studies.

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Data availability

All data generated and analysed are included in this study. Further enquiries can be directed to the corresponding author regarding acquisition of raw data as well as all water composition reports utilised in this investigation.

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Acknowledgements

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No funds, grants, or other support was received for conducting this study.

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Authors and Affiliations

  1. Department of Urology, Rochdale Infirmary, Northern Care Alliance NHS Foundation Trust, Whitehall Street, Rochdale, Greater Manchester, OL12 0NB, UK

    Kirolos G. F. T. Michael, Andreas Bourdoumis & Raveendra Surange

  2. Wythenshawe Hospital, Manchester University NHS Foundation Trust, Greater Manchester, UK

    Sarah Michael

  3. Department of Urology, East Lancashire Hospital NHS Trust, Blackburn, UK

    Ehab Abusada & Shalom J. Srirangam

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  1. Kirolos G. F. T. Michael
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  6. Raveendra Surange
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Contributions

KM: conceptualization, methodology, investigation, data curation, writing—original draft preparation. SM: data curation, formal analysis, visualisation, writing—original draft. EA: investigation, writing— review and editing. sjs: investigation, writing—review and editing. AB: investigation, writing—review and editing. RS: supervision, writing—review and editing.

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Correspondence to Kirolos G. F. T. Michael.

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The authors declare no competing interests.

Conflict of interest

This study complies with the ethical principles for medical research involving human subjects as set out by the World Medical Association Declaration of Helsinki. Ethics approval from the NHS Research Ethics Committee (REC) was not required in accordance with NHS Medical Research Council regulations in the United Kingdom since retrospectively collected data were available as part of routine patient care and strict confidentiality and non-identifiability of patient data was maintained throughout and between centres. Written informed consent was not required due to this study’s non-interventional, retrospective design.

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Michael, K.G.F.T., Michael, S., Abusada, E. et al. Does the mineral content of tap water correlate with urinary calculus composition?. Urolithiasis 50, 691–699 (2022). https://doi.org/10.1007/s00240-022-01358-7

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