Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis — a prospective randomized study

Hofbauer, J.; Höbarth, K.; Szabo, Norbert; Marberger, Michael

doi:10.1111/j.1464-410x.1994.tb07597.x

Cited by 122 publications

(55 citation statements)

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“…Both sodium potassium citrate and potassium citrate alter urinary composition favourably [63][64][65][66][67][68][69], but the admixture of sodium might result in an increased calcium excretion or a less pronounce reduction in urinary calcium [37,70]. Clinical studies subsequently indicated that potassium citrate is superior to sodium potassium citrate in counteracting stone formation [71].…”

Section: Alkaline Citratementioning

confidence: 99%

Epidemiology and medical management of stone disease

2003

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SUMMARYRecurrent stone formation in the urinary tract is a common and important problem that must be considered in daily urological practice. With a prevalence of> 10% and an expected recurrence rate of ≈ 50%, stone disease has an important effect on the healthcare system. It is generally agreed that patients with uric acid/urate, cystine or infection stones always should be treated pharmacologically. For calcium stone formers the treatment should be chosen according to the severity of the disease. Recurrence in patients with calcium‐stone disease can be prevented with general or specific dietary and drinking advice, and with pharmacological therapy. For idiopathic calcium stone formers the most convincing therapeutic effects have been reported with thiazide and alkaline citrate.

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Section: Alkaline Citratementioning

confidence: 99%

Epidemiology and medical management of stone disease

2003

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“…Several authors supported the benefit of alkaline citrates in all patients undergoing shockwave lithotripsy for the significant improvement in rates of alleviation the calcium oxalate stone-forming activity and positively influence the preexisting stone clearance and dissolution with minor adverse reaction (2,11,(14)(15)(16). The studies with stone recurrence as the endpoint demonstrated a reduction in stone-forming rate from 47% to 100%.…”

Section: Discussionmentioning

confidence: 96%

“…The studies with stone recurrence as the endpoint demonstrated a reduction in stone-forming rate from 47% to 100%. Of four randomized controlled trials, the stone-free rate after at least two years of alkaline citrate treatment was 53.5% and 35% in treatment and placebo groups, respectively (3,(14)(15)(16). For three years, in idiopathic hypocitraturic calcium nephrolithiasis patients who received potassium citrate, the stone formation per year significantly declined from 1.20.6 to 0.1 ± 0.2 stones per patient.…”

Section: Discussionmentioning

confidence: 99%

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

et al. 2011

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Objective: To evaluate the preventive effects of alkaline citrate on stone recurrence as well as stone growth post-ESWL or PCNL in patients with calcium-containing stones. Materials and Methods: A total of 76 patients with calcium calculi who were stone-free or had residual stones less than 4 mm following ESWL and PCNL were enrolled. All patients were independently randomized into two groups. The treated group (N = 39) was given 81 mEq per day of oral potassium-sodium citrate (27 mEq three times a day), and the untreated group (N = 37) serving as controls. Blood, twenty-four hour urine analysis, and plain KUB were measured and compared at the baseline and after 12 months. Results: At baseline, hypocitraturia was found in 20 of 39 patients (46.05%) of Group I and 15 of 37 patients (40.5%) of Group II. At 12 months, hypocitraturia was found in 3 of 39 (7.69%) and 14 of 37 (37.83%) of Group I and Group II, respectively (p = 0.007). At the 12 month follow-up, of the stone-free group, 92.3% of the treated group and 57.7% of the control group were still stone free. Of the residual stone group, 30.8% and 9.1 % of treated and control group were stone-free, respectively. The increased stone size found in 7.7% and 54.5% of treated and control groups, respectively. Conclusion: Sodium-potassium citrate provides positive effects on stone-forming activities in calcium stone patients suffering from urolithiasis following treatment with ESWL and PCNL procedures at the 12-month follow-up. With the advantage of high efficiency and low morbidity rates, extracorporeal shock wave lithotripsy (ESWL) has become the therapy of choice for small renal stones. Percutaneous nephrolithotomy (PCNL) is also becoming the therapy of choice for large renal stones due to the less invasive procedure as compared to open nephrolithotomy. These therapies provide good results, associated with an acceptable rate of complications, but unfortunately they do not change the underlying metabolic abnormality. Stone recurrence is usually found after either treatment, even in those with a stone-free post-therapy status. In addition, retained stone fragments following those therapies may reaggregate or constitute a nucleus for new stone formation, thereby causing a high rate of stone growth (1-4). The patient's chances of first episode recurrent stone formation range between 27% and 50% (5,6). Medical treatment should therefore be considered following these interventions, in order to prevent further secondary treatments and hospitalizations. Among the metabolic disorders usually found in recurrent stone forming patients, hypocitraturia Clinical Urology

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“…9 Some positive trials of citrate did not require the intervention group to have hypocitruria. 10,11 In other words, citrate supplementation helps recurrent stone formers with normal range baseline urinary citrate. The same is true for several thiazide trials, which did not require hypercalciuria as an inclusion criterion.…”

Section: Drawbacksmentioning

confidence: 99%

The Role of the 24-Hour Urine Collection in the Prevention of Kidney Stone Recurrence

et al. 2017

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Purpose: Kidney stone prevention relies on the 24-hour urine collection to diagnose metabolic abnormalities and direct dietary and pharmacological therapy. While its use is guideline supported for high risk and interested patients, evidence that the test can accurately predict recurrence or treatment response is limited. We sought to critically reassess the role of the 24-hour urine collection in stone prevention. Materials and Methods: In addition to a MEDLINEÒ search to identify controlled studies of dietary and pharmacological interventions, evidence supporting the AUA (American Urological Association) and EAU (European Association of Urology) guidelines for metabolic stone prevention were evaluated. Additionally, the placebo arms of these studies were examined to assess the stone clinic effect, that is the impact of regular office visits without specific treatment on stone recurrence. Results: The 24-hour urine test has several limitations, including the complexity of interpretation, the need for repeat collections, the inability to predict stone recurrence with individual parameters and supersaturation values, the unclear rationale of laboratory cutoff values and the difficulty of determining collection adequacy. Only 1 prospective trial has compared selective dietary recommendations based on 24-hour urine collection results vs general dietary instructions. While the trial supported the intervention arm, significant limitations to the study were found. Placebo arms of intervention trials have noted a 0% to 61% decrease in stone recurrence rate and a remission rate during the study of 20% to 86%. Conclusions: Whether all recurrent stone formers benefit from 24-hour urine collection has not been established. Additional comparative effectiveness trials are needed to determine which stone former benefits from selective therapy, as guided by the 24-hour urine collection.

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Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis — a prospective randomized study

Abstract: An objective benefit of alkali citrate could not be established.

Cited by 122 publications

References 18 publications

Epidemiology and medical management of stone disease

Epidemiology and medical management of stone disease

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

The Role of the 24-Hour Urine Collection in the Prevention of Kidney Stone Recurrence

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