Prevention of Calcium Renal Stones with Citrate Therapy

Clinical Evidence and Treatment Recommendations

• The American Urological Association (AUA) strongly recommends potassium citrate therapy for patients with recurrent calcium stones and low or relatively low urinary citrate 1
• Potassium citrate therapy has been shown to reduce new stone formation rates in patients with calcium stones and low urinary citrate 1
• Hypokalemia stimulates tubular citrate reabsorption, decreasing urinary citrate excretion 2
• High dietary sodium intake can reduce urinary citrate excretion 2
• High animal protein consumption represents an acid load that reduces urinary citrate excretion 2, 3
• Potassium citrate is preferred over sodium citrate, as sodium load may increase urine calcium excretion 1, 4

Adjunctive Measures to Enhance Citrate Therapy

• Increased fluid intake to maintain adequate urine volume 1, 5
• Sodium restriction to help reduce urinary calcium excretion 1, 3
• Increased consumption of fruits and vegetables to provide an alkali load that increases urinary citrate excretion 1, 2
• Limiting animal protein intake to reduce acid load 2, 3