Goodman Jeffrey W, Asplin John R, Goldfarb David S
NYU School of Medicine, New York, NY 10010, USA.
Urol Res. 2009 Feb;37(1):41-6. doi: 10.1007/s00240-008-0166-0. Epub 2008 Dec 10.
The effect of commercial oral rehydration solutions ("sports drinks") relative to water on risk of nephrolithiasis has not been studied previously. We studied the effect of two sports drinks, Performance (Shaklee Corp., Pleasanton, CA, USA) and Gatorade (Gatorade, Chicago, IL, USA) on urinary chemistry and measures of lithogenicity in non-stone formers. Performance has a pH of 4.3, and contains 21 mmol/L of sodium, 5.3 mmol/L of potassium, 0.8 mmol/L of calcium, and 19.5 mmol/L of citrate. Gatorade pH ranges from 2.9 to 3.2, and contains 20 mmol/L of sodium, 3.2 mmol/L of potassium, negligible calcium, and 13.9 mmol/L of citrate. Subjects drank 946 ml (32 oz) of tap water daily for 3 days, and recorded diet history. This was followed by a second 3-day experimental period during which subjects drank 946 ml (32 oz) of sports drink daily, duplicating diets from part 1. In each 3-day period, urine was collected for 24 h during days 2 and 3. Urine chemical analysis was performed, and supersaturations of calcium oxalate, calcium phosphate and uric acid were calculated. Nine subjects completed the study using Performance, ten used Gatorade. Urine volumes and creatinine excretions were not different during the control and experimental periods. Performance increased mean citrate excretion by 170 mg/day (95% CI 57-284 mg/day; P = 0.01) and increased urine pH by 0.31 (95% CI 0.03-0.59; P = 0.03). Gatorade did not significantly change urinary citrate excretion or pH. Neither drink caused significant differences in the excretion of sodium and calcium or any supersaturation value. Ingestion of Performance, but not Gatorade, led to an increase in mean urinary citrate excretion and pH as compared to water. The increase in citrate is likely to be a clinically significant effect. pH is an important determinant of alkali load in beverages containing organic anions. Performance, with more citrate and a higher pH than Gatorade, could represent a superior alternative to water for reducing urinary lithogenicity. Most sports drinks with significant carbohydrate content however may contain too many calories, and fructose, to be preferred beverages for stone prevention.
此前尚未研究过市售口服补液溶液（“运动饮料”）相对于水对肾结石风险的影响。我们研究了两种运动饮料，Performance（美国加利福尼亚州普莱森顿的Shaklee公司）和佳得乐（美国伊利诺伊州芝加哥的佳得乐公司）对非结石形成者尿液化学成分和致石性指标的影响。Performance的pH值为4.3，含有21毫摩尔/升的钠、5.3毫摩尔/升的钾、0.8毫摩尔/升的钙和19.5毫摩尔/升的柠檬酸盐。佳得乐的pH值范围为2.9至3.2，含有20毫摩尔/升的钠、3.2毫摩尔/升的钾、可忽略不计的钙和13.9毫摩尔/升的柠檬酸盐。受试者连续3天每天饮用946毫升（32盎司）自来水，并记录饮食史。随后是第二个为期3天的实验期，在此期间受试者每天饮用946毫升（32盎司）运动饮料，重复第一部分的饮食。在每个为期3天的时间段内，在第2天和第3天收集24小时尿液。进行尿液化学分析，并计算草酸钙、磷酸钙和尿酸的过饱和度。9名受试者使用Performance完成了研究，10名使用了佳得乐。对照期和实验期的尿量和肌酐排泄量没有差异。Performance使平均柠檬酸盐排泄量增加了170毫克/天（95%置信区间57 - 284毫克/天；P = 0.01），尿液pH值增加了0.31（95%置信区间0.03 - 0.59；P = 0.03）。佳得乐对尿液柠檬酸盐排泄或pH值没有显著影响。两种饮料在钠和钙的排泄或任何过饱和度值方面均未引起显著差异。与水相比，饮用Performance而非佳得乐会导致平均尿液柠檬酸盐排泄量和pH值增加。柠檬酸盐的增加可能具有临床显著意义。pH值是含有有机阴离子的饮料中碱负荷的重要决定因素。与佳得乐相比，Performance含有更多柠檬酸盐且pH值更高，可能是降低尿液致石性的更优水替代品。然而，大多数含有大量碳水化合物的运动饮料可能含有过多热量和果糖，并非预防结石的首选饮品。
