Potassium Citrate Supplementation vs. Dietary Counseling

Launched by UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL · Nov 1, 2013

Keywords

ClinConnect Summary

The prevalence of kidney stone disease in the United States is increasing. Concurrently, an increase in calcium phosphate stone composition is also being observed. Recurrence of kidney stone disease has been reported as high as 50% at five years. Citrate supplementation is widely considered as one of the primary medical cornerstones to decrease kidney stone recurrence. Urinary citrate is a potent inhibitor of calcium stone formation by binding ionic urinary calcium as well as direct inhibition of calcium oxalate formation. Additionally, increased citrate, an alkali, raises urine pH which al...

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Eligibility criteria

• Inclusion Criteria:
• • 1. Patients ≥ 18 years old, being seen at UNC Chapel Hill or Vanderbilt Urology Clinics
• • 2. Documented stone analysis with ≥ 50% calcium phosphate (hydroxyapatite and/or brushite) composition
• • 3. 24 hour urine citrate (≤ 500) on initial evaluation of at least one 24-hour urine study
• • 4. 24 hour urine pH ≥ 6.0 on initial evaluation of at least one 24-hour urine study
• Exclusion Criteria:
• • 1. Documented stone analysis with any calcium carbonate or magnesium ammonium phosphate composition
• • 2. Systemic cause for stone disease (primary hyperparathyroidism, complete distal renal tubular acidosis, systemic acidosis, active urinary tract infection)
• • 3. 24 hour urine calcium/kg (\> 4) or 24 hour urine calcium/Cr (\>140) on initial evaluation of at least one 24-hour urine study
• • 4. Concurrent medication therapy (potassium citrate, sodium citrate, sodium bicarbonate, diuretic, angiotensin-converting enzyme inhibitor, angiotensin II receptor antagonist, topiramate, acetazolamide)
• • 5. Renal insufficiency (GFR ≤ 60)
• • 6. Elevated serum potassium level (≥ 4.5) or hyperkalemia
• • 7. Low serum bicarbonate level (\< 24)
• • 8. High serum calcium level (\>10)
• • 9. Pregnancy
• • 10. Inability to obtain informed consent