Prevention of Recurrent Kidney Stones: A CARI Guidelines Summary

Introduction: The incidence of kidney stones is increasing in Australia and Aotearoa New Zealand, increasing pressure on emergency departments for acute pain management and stretching nephrology and dietetics services tasked with preventing recurrence. To address this, the Caring for Australians and New ZealandeRs with kidney Impairment (CARI) guidelines provide evidence-based recommendations that complement urological and surgical care, contextualized for our region and developed with input from people with lived experience. Methods: Guidelines were developed through a 5-stage process aligned with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A multidisciplinary working group formulated Population Intervention/Exposure Comparator Outcome Methodology questions, and a group of consumers in a dedicated workshop scoped guideline topics. A systematic literature review was conducted, prioritizing high-quality evidence that was critically appraised and synthesized. Recommendations were drafted using the GRADE Evidence-to-Decision framework, incorporating perspectives of lived experience throughout. Results: These guidelines provide recommendations on the diagnosis, metabolic evaluation, and management to prevent recurrent kidney stones. Nutrition therapy provided by dietitians with expertise is a fundamental and cost-effective intervention for preventing recurrent kidney stones. Although nutrition therapy should precede pharmacological interventions in most cases, the use of potassium citrate and thiazide diuretics may be considered when nutrition therapy alone is insufficient. Conclusion: These CARI guidelines address a critical gap in the management of kidney stones in Australia and New Zealand by providing evidence-based, contextualized recommendations to support nephrologists, dietitians with expertise in kidney stones, and other health professionals in delivering consistent, high-quality care that reduces kidney stone recurrence and improves outcomes.