Tags

Type your tag names separated by a space and hit enter

Impact of Potassium Citrate vs Citric Acid on Urinary Stone Risk in Calcium Phosphate Stone Formers.
J Urol 2018; 200(6):1278-1284JU

Abstract

PURPOSE

To our knowledge no medication has been shown to be effective for preventing recurrent calcium phosphate urinary stones. Potassium citrate may protect against calcium phosphate stones by enhancing urine citrate excretion and lowering urine calcium but it raises urine pH, which increases calcium phosphate saturation and may negate the beneficial effects. Citric acid can potentially raise urine citrate but not pH and, thus, it may be a useful countermeasure against calcium phosphate stones. We assessed whether these 2 agents could significantly alter urine composition and reduce calcium phosphate saturation.

MATERIALS AND METHODS

In a crossover metabolic study 13 recurrent calcium phosphate stone formers without hypercalciuria were evaluated at the end of 3, 1-week study phases during which they consumed a fixed metabolic diet and received assigned study medications, including citric acid 30 mEq twice daily, potassium citrate 20 mEq twice daily or matching placebo. We collected 24-hour urine specimens to perform urine chemistry studies and calculate calcium phosphate saturation indexes.

RESULTS

Urine parameters did not significantly differ between the citric acid and placebo phases. Potassium citrate significantly increased urine pH, potassium and citrate compared to citric acid and placebo (p <0.01) with a trend toward lower urine calcium (p = 0.062). Brushite saturation was increased by potassium citrate when calculated by the relative supersaturation ratio but not by the saturation index.

CONCLUSIONS

Citric acid at a dose of 60 mEq per day did not significantly alter urine composition in calcium phosphate stone formers. The long-term impact of potassium citrate on calcium phosphate stone recurrence needs to be studied further.

Authors+Show Affiliations

Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas.Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas.Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas.Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Physiology, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Mineral Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Mineral Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: naim.maalouf@utsouthwestern.edu.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30036516

Citation

Doizi, Steeve, et al. "Impact of Potassium Citrate Vs Citric Acid On Urinary Stone Risk in Calcium Phosphate Stone Formers." The Journal of Urology, vol. 200, no. 6, 2018, pp. 1278-1284.
Doizi S, Poindexter JR, Pearle MS, et al. Impact of Potassium Citrate vs Citric Acid on Urinary Stone Risk in Calcium Phosphate Stone Formers. J Urol. 2018;200(6):1278-1284.
Doizi, S., Poindexter, J. R., Pearle, M. S., Blanco, F., Moe, O. W., Sakhaee, K., & Maalouf, N. M. (2018). Impact of Potassium Citrate vs Citric Acid on Urinary Stone Risk in Calcium Phosphate Stone Formers. The Journal of Urology, 200(6), pp. 1278-1284. doi:10.1016/j.juro.2018.07.039.
Doizi S, et al. Impact of Potassium Citrate Vs Citric Acid On Urinary Stone Risk in Calcium Phosphate Stone Formers. J Urol. 2018;200(6):1278-1284. PubMed PMID: 30036516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Potassium Citrate vs Citric Acid on Urinary Stone Risk in Calcium Phosphate Stone Formers. AU - Doizi,Steeve, AU - Poindexter,John R, AU - Pearle,Margaret S, AU - Blanco,Francisco, AU - Moe,Orson W, AU - Sakhaee,Khashayar, AU - Maalouf,Naim M, Y1 - 2018/07/20/ PY - 2018/07/07/accepted PY - 2019/12/01/pmc-release PY - 2018/7/24/pubmed PY - 2019/6/7/medline PY - 2018/7/24/entrez KW - calcium phosphates KW - citric acid KW - potassium citrate KW - urinary tract KW - urolithiasis SP - 1278 EP - 1284 JF - The Journal of urology JO - J. Urol. VL - 200 IS - 6 N2 - PURPOSE: To our knowledge no medication has been shown to be effective for preventing recurrent calcium phosphate urinary stones. Potassium citrate may protect against calcium phosphate stones by enhancing urine citrate excretion and lowering urine calcium but it raises urine pH, which increases calcium phosphate saturation and may negate the beneficial effects. Citric acid can potentially raise urine citrate but not pH and, thus, it may be a useful countermeasure against calcium phosphate stones. We assessed whether these 2 agents could significantly alter urine composition and reduce calcium phosphate saturation. MATERIALS AND METHODS: In a crossover metabolic study 13 recurrent calcium phosphate stone formers without hypercalciuria were evaluated at the end of 3, 1-week study phases during which they consumed a fixed metabolic diet and received assigned study medications, including citric acid 30 mEq twice daily, potassium citrate 20 mEq twice daily or matching placebo. We collected 24-hour urine specimens to perform urine chemistry studies and calculate calcium phosphate saturation indexes. RESULTS: Urine parameters did not significantly differ between the citric acid and placebo phases. Potassium citrate significantly increased urine pH, potassium and citrate compared to citric acid and placebo (p <0.01) with a trend toward lower urine calcium (p = 0.062). Brushite saturation was increased by potassium citrate when calculated by the relative supersaturation ratio but not by the saturation index. CONCLUSIONS: Citric acid at a dose of 60 mEq per day did not significantly alter urine composition in calcium phosphate stone formers. The long-term impact of potassium citrate on calcium phosphate stone recurrence needs to be studied further. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/30036516/Impact_of_Potassium_Citrate_vs_Citric_Acid_on_Urinary_Stone_Risk_in_Calcium_Phosphate_Stone_Formers_ L2 - https://www.jurology.com/doi/full/10.1016/j.juro.2018.07.039?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -