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Causes of hypocitraturia in recurrent calcium stone formers: focusing on urinary potassium excretion.
Am J Kidney Dis. 2006 Oct; 48(4):546-54.AJ

Abstract

BACKGROUND

Multiple factors associated with hypocitraturia have been identified. However, limited studies addressing the causal relationship to hypocitraturia are available. We therefore conducted this study to determine factors associated with hypocitraturia and show their causal relationship in recurrent calcium stone formers.

METHODS

Dietary review and 24-hour urine samples were obtained from all recurrent calcium stone formers referred for metabolic workup in the stone clinic. One month of oral potassium chloride supplementation was prescribed to stone formers to determine the causal relationship between urinary potassium and citrate levels.

RESULTS

Eighty-three subjects, 44 men and 39 women, were recruited to participate in this study. Hypocitraturia (citrate < 300 mg/d [<1.43 mmol/d]) was found in 50.6% of subjects. Four independent urinary variables associated with hypocitraturia were identified, including potassium level, net gastrointestinal alkaline absorption, calcium level, and titratable acid. Urinary potassium level was the strongest predictor of urinary citrate level. Hypocitraturic subjects also had lower fruit intake compared with subjects with high urinary citrate levels. Potassium chloride supplementation to a subgroup of this population (n = 58) resulted in a significant increase in urinary citrate excretion (350.73 +/- 27.25 versus 304.15 +/- 30.00 mg/d [1.67 +/- 0.13 versus 1.45 +/- 0.14 mmol/d]; P < 0.02), but no alteration in fractional excretion of citrate (19.7% +/- 2.7% versus 23.1% +/- 2.4%; P > 0.05).

CONCLUSION

Hypocitraturia was found to be a common risk factor associated with recurrent calcium stone formation and low urinary potassium level, low alkaline absorption, low urinary calcium level, and high titratable acid excretion. Hypocitraturia is predominantly of dietary origin. Estimation of fruit intake should be included in the metabolic evaluation for recurrent calcium stone formation.

Authors+Show Affiliations

Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rasdr@mahidol.ac.thNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

16997050

Citation

Domrongkitchaiporn, Somnuek, et al. "Causes of Hypocitraturia in Recurrent Calcium Stone Formers: Focusing On Urinary Potassium Excretion." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 48, no. 4, 2006, pp. 546-54.
Domrongkitchaiporn S, Stitchantrakul W, Kochakarn W. Causes of hypocitraturia in recurrent calcium stone formers: focusing on urinary potassium excretion. Am J Kidney Dis. 2006;48(4):546-54.
Domrongkitchaiporn, S., Stitchantrakul, W., & Kochakarn, W. (2006). Causes of hypocitraturia in recurrent calcium stone formers: focusing on urinary potassium excretion. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 48(4), 546-54.
Domrongkitchaiporn S, Stitchantrakul W, Kochakarn W. Causes of Hypocitraturia in Recurrent Calcium Stone Formers: Focusing On Urinary Potassium Excretion. Am J Kidney Dis. 2006;48(4):546-54. PubMed PMID: 16997050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Causes of hypocitraturia in recurrent calcium stone formers: focusing on urinary potassium excretion. AU - Domrongkitchaiporn,Somnuek, AU - Stitchantrakul,Wasana, AU - Kochakarn,Wachira, PY - 2005/12/08/received PY - 2006/06/12/accepted PY - 2006/9/26/pubmed PY - 2006/10/13/medline PY - 2006/9/26/entrez SP - 546 EP - 54 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 48 IS - 4 N2 - BACKGROUND: Multiple factors associated with hypocitraturia have been identified. However, limited studies addressing the causal relationship to hypocitraturia are available. We therefore conducted this study to determine factors associated with hypocitraturia and show their causal relationship in recurrent calcium stone formers. METHODS: Dietary review and 24-hour urine samples were obtained from all recurrent calcium stone formers referred for metabolic workup in the stone clinic. One month of oral potassium chloride supplementation was prescribed to stone formers to determine the causal relationship between urinary potassium and citrate levels. RESULTS: Eighty-three subjects, 44 men and 39 women, were recruited to participate in this study. Hypocitraturia (citrate < 300 mg/d [<1.43 mmol/d]) was found in 50.6% of subjects. Four independent urinary variables associated with hypocitraturia were identified, including potassium level, net gastrointestinal alkaline absorption, calcium level, and titratable acid. Urinary potassium level was the strongest predictor of urinary citrate level. Hypocitraturic subjects also had lower fruit intake compared with subjects with high urinary citrate levels. Potassium chloride supplementation to a subgroup of this population (n = 58) resulted in a significant increase in urinary citrate excretion (350.73 +/- 27.25 versus 304.15 +/- 30.00 mg/d [1.67 +/- 0.13 versus 1.45 +/- 0.14 mmol/d]; P < 0.02), but no alteration in fractional excretion of citrate (19.7% +/- 2.7% versus 23.1% +/- 2.4%; P > 0.05). CONCLUSION: Hypocitraturia was found to be a common risk factor associated with recurrent calcium stone formation and low urinary potassium level, low alkaline absorption, low urinary calcium level, and high titratable acid excretion. Hypocitraturia is predominantly of dietary origin. Estimation of fruit intake should be included in the metabolic evaluation for recurrent calcium stone formation. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16997050/Causes_of_hypocitraturia_in_recurrent_calcium_stone_formers:_focusing_on_urinary_potassium_excretion_ DB - PRIME DP - Unbound Medicine ER -