These limitations notwithstanding, our findings haveimportant implications for treating patients with kidneystones in the United States. Continued increases in
prevalence will presumably sustain recent increases inhealth care expenditures for treating patients with stonedisease [2,22]. Currently, patient treatment is characterizedprimarily by surgical intervention for symptomatic stoneevents rather than management of the chronic metaboliccondition that leads to recurrence in 50% of patientswithin 5 yr in a primarily working-age population [23].Evidence from randomized controlled trialssuggeststhatlifestyle and pharmacologic interventions are effective forsecondary prevention of kidney stones[24–27]. The rapidlychanging prevalence of kidney stones suggests that furtherefforts toward secondary prevention may be indicated.