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Reduction of renal stone risk by potassium-magnesium citrate during 5 weeks of bed rest.
J Urol. 2007 Jun; 177(6):2179-84.JU

Abstract

PURPOSE

Exposure to the microgravity environment of space increases the risk of kidney stone formation, particularly for calcium oxalate and uric acid stones. This study was performed to evaluate the efficacy of potassium alkali as potassium-magnesium citrate in reducing renal stone risk and bone turnover.

MATERIALS AND METHODS

This study was performed as a double-blind, placebo controlled trial. We studied 20 normocalciuric subjects randomized to either placebo or potassium-magnesium citrate (42 mEq potassium, 21 mEq magnesium, 63 mEq citrate per day) before and during 5 weeks of strict bed rest. The study was performed in the General Clinical Research Center and under a controlled dietary regimen composed of 100 mEq of sodium, 800 mg of calcium, 0.8 gm/kg animal protein and 2,200 kcal per day. Two 24-hour urine collections were obtained under oil each week for assessment of stone risk parameters and relative saturation of calcium oxalate, brushite and undissociated uric acid. Blood was also collected for determination of serum immunoreactive parathyroid hormone and vitamin D metabolites.

RESULTS

Bed rest promoted a rapid increase in urinary calcium excretion of approximately 50 mg per day in both groups. Despite this increase subjects treated with potassium-magnesium citrate demonstrated significant decreases in the relative saturation of calcium oxalate and in the concentration of undissociated uric acid compared to placebo. Immunoreactive parathyroid hormone, serum 1,25-dihydroxyvitamin D and intestinal calcium absorption all decreased in both groups with no difference in response between the 2 treatment arms.

CONCLUSIONS

Provision of alkali as potassium-magnesium citrate is an effective countermeasure for the increased risk of renal stone disease associated with immobilization. Despite an increase in urine calcium concentration, the relative saturation of calcium oxalate decreased due to citrate chelation of calcium and the concentration of undissociated uric acid decreased due to the significant increase in urine pH.

Authors+Show Affiliations

Center for Mineral Metabolism and Clinical Research, and the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. joseph.zerwekh@utsouthwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17509313

Citation

Zerwekh, Joseph E., et al. "Reduction of Renal Stone Risk By Potassium-magnesium Citrate During 5 Weeks of Bed Rest." The Journal of Urology, vol. 177, no. 6, 2007, pp. 2179-84.
Zerwekh JE, Odvina CV, Wuermser LA, et al. Reduction of renal stone risk by potassium-magnesium citrate during 5 weeks of bed rest. J Urol. 2007;177(6):2179-84.
Zerwekh, J. E., Odvina, C. V., Wuermser, L. A., & Pak, C. Y. (2007). Reduction of renal stone risk by potassium-magnesium citrate during 5 weeks of bed rest. The Journal of Urology, 177(6), 2179-84.
Zerwekh JE, et al. Reduction of Renal Stone Risk By Potassium-magnesium Citrate During 5 Weeks of Bed Rest. J Urol. 2007;177(6):2179-84. PubMed PMID: 17509313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduction of renal stone risk by potassium-magnesium citrate during 5 weeks of bed rest. AU - Zerwekh,Joseph E, AU - Odvina,Clarita V, AU - Wuermser,Lisa-Ann, AU - Pak,Charles Y C, PY - 2006/10/17/received PY - 2007/5/19/pubmed PY - 2007/7/18/medline PY - 2007/5/19/entrez SP - 2179 EP - 84 JF - The Journal of urology JO - J. Urol. VL - 177 IS - 6 N2 - PURPOSE: Exposure to the microgravity environment of space increases the risk of kidney stone formation, particularly for calcium oxalate and uric acid stones. This study was performed to evaluate the efficacy of potassium alkali as potassium-magnesium citrate in reducing renal stone risk and bone turnover. MATERIALS AND METHODS: This study was performed as a double-blind, placebo controlled trial. We studied 20 normocalciuric subjects randomized to either placebo or potassium-magnesium citrate (42 mEq potassium, 21 mEq magnesium, 63 mEq citrate per day) before and during 5 weeks of strict bed rest. The study was performed in the General Clinical Research Center and under a controlled dietary regimen composed of 100 mEq of sodium, 800 mg of calcium, 0.8 gm/kg animal protein and 2,200 kcal per day. Two 24-hour urine collections were obtained under oil each week for assessment of stone risk parameters and relative saturation of calcium oxalate, brushite and undissociated uric acid. Blood was also collected for determination of serum immunoreactive parathyroid hormone and vitamin D metabolites. RESULTS: Bed rest promoted a rapid increase in urinary calcium excretion of approximately 50 mg per day in both groups. Despite this increase subjects treated with potassium-magnesium citrate demonstrated significant decreases in the relative saturation of calcium oxalate and in the concentration of undissociated uric acid compared to placebo. Immunoreactive parathyroid hormone, serum 1,25-dihydroxyvitamin D and intestinal calcium absorption all decreased in both groups with no difference in response between the 2 treatment arms. CONCLUSIONS: Provision of alkali as potassium-magnesium citrate is an effective countermeasure for the increased risk of renal stone disease associated with immobilization. Despite an increase in urine calcium concentration, the relative saturation of calcium oxalate decreased due to citrate chelation of calcium and the concentration of undissociated uric acid decreased due to the significant increase in urine pH. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/17509313/Reduction_of_renal_stone_risk_by_potassium_magnesium_citrate_during_5_weeks_of_bed_rest_ L2 - https://www.jurology.com/doi/full/10.1016/j.juro.2007.01.156?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -