Rethinking vitamin D supplementation in calcium stone formers
Bibliographic record
Abstract
I n this month's CUAJ, Basulto-Martínez et al provide a valuable contribution to the ongoing debate over vitamin D supplementation in patients with kidney stones. 1 They report vitamin D deficiency in 34% of 748 calcium stone formers, consistent with a 2010 Canadian stone clinic cohort 2 and slightly higher than the 29% observed in the general Canadian population. 3Of note, the authors routinely measured serum vitamin D as part of the baseline metabolic workup, suggesting that the observed low vitamin D levels are representative of the overall kidney stone population in Canada.Furthermore, with a median followup of 4.8 years, outcomes in 83 calcium stone formers receiving vitamin D supplementation were assessed.Significant stone growth was present on imaging in 71% of those who remained vitamin D-deficient, compared with 35% of vitamin D-replete patients.Historically, hesitancy to prescribe vitamin D in stone formers has stemmed from conflicting evidence.While some studies have linked higher vitamin D levels to normocalciuria, 4 others have reported associations with hypercalciuria. 5Meta-analyses have suggested that vitamin D, especially with calcium cosupplementation, may increase kidney stone risk, 6,7 and that higher vitamin D levels alone could also be linked to greater risk. 8ore recent studies, however, are reassuring: vitamin D supplementation alone appears to have minimal lithogenic impact, even though hypercalcemia and hypercalciuria may occur. 9When controlling for concurrent calcium supplementation, the association between vitamin D and stone formation is further diminished. 10This evidence is reflected in the current Canadian Urological Association (CUA) guideline on kidney stones, which recommends vitamin D repletion in stone formers with deficiency, providing urinary monitoring is performed. 11evertheless, caution remains warranted.Some studies showing no increase in stone risk had relatively short followup periods -six weeks, 12 eight weeks, 13 16 weeks 14 -and most often assessed stone risk through urinary parameters rather than stone recurrence.The present study reinforces that vitamin D deficiency is common among Canadian calcium oxalate
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".