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Effect of Potassium Citrate on Calcium Phosphate Stones in a Model of Hypercalciuria.
J Am Soc Nephrol 2015; 26(12):3001-8JA

Abstract

Potassium citrate is prescribed to decrease stone recurrence in patients with calcium nephrolithiasis. Citrate binds intestinal and urine calcium and increases urine pH. Citrate, metabolized to bicarbonate, should decrease calcium excretion by reducing bone resorption and increasing renal calcium reabsorption. However, citrate binding to intestinal calcium may increase absorption and renal excretion of both phosphate and oxalate. Thus, the effect of potassium citrate on urine calcium oxalate and calcium phosphate supersaturation and stone formation is complex and difficult to predict. To study the effects of potassium citrate on urine supersaturation and stone formation, we utilized 95th-generation inbred genetic hypercalciuric stone-forming rats. Rats were fed a fixed amount of a normal calcium (1.2%) diet supplemented with potassium citrate or potassium chloride (each 4 mmol/d) for 18 weeks. Urine was collected at 6, 12, and 18 weeks. At 18 weeks, stone formation was visualized by radiography. Urine citrate, phosphate, oxalate, and pH levels were higher and urine calcium level was lower in rats fed potassium citrate. Furthermore, calcium oxalate and calcium phosphate supersaturation were higher with potassium citrate; however, uric acid supersaturation was lower. Both groups had similar numbers of exclusively calcium phosphate stones. Thus, potassium citrate effectively raises urine citrate levels and lowers urine calcium levels; however, the increases in urine pH, oxalate, and phosphate levels lead to increased calcium oxalate and calcium phosphate supersaturation. Potassium citrate induces complex changes in urine chemistries and resultant supersaturation, which may not be beneficial in preventing calcium phosphate stone formation.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; Nancy_Krieger@urmc.rochester.edu.Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois; and.Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York;Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois; and.Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York;Laboratory Medicine and Pathobiology Department, University of Toronto, Toronto, Ontario, Canada.Laboratory Medicine and Pathobiology Department, University of Toronto, Toronto, Ontario, Canada.Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York;

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25855777

Citation

Krieger, Nancy S., et al. "Effect of Potassium Citrate On Calcium Phosphate Stones in a Model of Hypercalciuria." Journal of the American Society of Nephrology : JASN, vol. 26, no. 12, 2015, pp. 3001-8.
Krieger NS, Asplin JR, Frick KK, et al. Effect of Potassium Citrate on Calcium Phosphate Stones in a Model of Hypercalciuria. J Am Soc Nephrol. 2015;26(12):3001-8.
Krieger, N. S., Asplin, J. R., Frick, K. K., Granja, I., Culbertson, C. D., Ng, A., ... Bushinsky, D. A. (2015). Effect of Potassium Citrate on Calcium Phosphate Stones in a Model of Hypercalciuria. Journal of the American Society of Nephrology : JASN, 26(12), pp. 3001-8. doi:10.1681/ASN.2014121223.
Krieger NS, et al. Effect of Potassium Citrate On Calcium Phosphate Stones in a Model of Hypercalciuria. J Am Soc Nephrol. 2015;26(12):3001-8. PubMed PMID: 25855777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Potassium Citrate on Calcium Phosphate Stones in a Model of Hypercalciuria. AU - Krieger,Nancy S, AU - Asplin,John R, AU - Frick,Kevin K, AU - Granja,Ignacio, AU - Culbertson,Christopher D, AU - Ng,Adeline, AU - Grynpas,Marc D, AU - Bushinsky,David A, Y1 - 2015/04/08/ PY - 2014/12/15/received PY - 2015/02/02/accepted PY - 2015/4/10/entrez PY - 2015/4/10/pubmed PY - 2016/3/29/medline KW - hypercalciuria KW - kidney stones KW - mineral metabolism SP - 3001 EP - 8 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 26 IS - 12 N2 - Potassium citrate is prescribed to decrease stone recurrence in patients with calcium nephrolithiasis. Citrate binds intestinal and urine calcium and increases urine pH. Citrate, metabolized to bicarbonate, should decrease calcium excretion by reducing bone resorption and increasing renal calcium reabsorption. However, citrate binding to intestinal calcium may increase absorption and renal excretion of both phosphate and oxalate. Thus, the effect of potassium citrate on urine calcium oxalate and calcium phosphate supersaturation and stone formation is complex and difficult to predict. To study the effects of potassium citrate on urine supersaturation and stone formation, we utilized 95th-generation inbred genetic hypercalciuric stone-forming rats. Rats were fed a fixed amount of a normal calcium (1.2%) diet supplemented with potassium citrate or potassium chloride (each 4 mmol/d) for 18 weeks. Urine was collected at 6, 12, and 18 weeks. At 18 weeks, stone formation was visualized by radiography. Urine citrate, phosphate, oxalate, and pH levels were higher and urine calcium level was lower in rats fed potassium citrate. Furthermore, calcium oxalate and calcium phosphate supersaturation were higher with potassium citrate; however, uric acid supersaturation was lower. Both groups had similar numbers of exclusively calcium phosphate stones. Thus, potassium citrate effectively raises urine citrate levels and lowers urine calcium levels; however, the increases in urine pH, oxalate, and phosphate levels lead to increased calcium oxalate and calcium phosphate supersaturation. Potassium citrate induces complex changes in urine chemistries and resultant supersaturation, which may not be beneficial in preventing calcium phosphate stone formation. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/25855777/Effect_of_Potassium_Citrate_on_Calcium_Phosphate_Stones_in_a_Model_of_Hypercalciuria_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=25855777 DB - PRIME DP - Unbound Medicine ER -