Cochrane for Clinicians

Putting Evidence into Practice

Citrate Salts for Preventing and Treating Calcium-Containing Kidney Stones in Adults

 

Am Fam Physician. 2017 May 1;95(9):552-553.

Author disclosure: No relevant financial affiliations.

Clinical Question

Do citrate salts treat and prevent calcium-containing kidney stones in adults?

Evidence-Based Answer

Citrate supplementation reduces stone size to less than 5 mm and prevents new stone formation when compared with placebo or no intervention. Citrate therapy also stabilizes existing stones and decreases the need for retreatment. These benefits come at the expense of upper gastrointestinal disturbances that lead to a higher dropout rate.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

In the United States, the prevalence of symptomatic kidney stones is 8.8% in the general population, and is higher in men (10.6%) and obese individuals (11.2%).2 Without prevention, 10% of individuals will have a symptomatic recurrence of stones at one year, 33% at five years, 50% at 10 years, and 75% at 20 years.3 Urinary tract stones represent an important health care expense with charges exceeding $10 billion annually in the United States.3 Because citrate binds urinary calcium, it may inhibit the formation of calcium oxalate stones; therefore, the authors of this Cochrane review aimed to determine if the use of citrate salts can prevent and treat calcium-containing kidney stones.

This Cochrane review included seven randomized controlled trials with a total of 477 participants.1 Three studies compared potassium citrate supplementation with placebo or no intervention, and three studies compared potassium-sodium citrate with no intervention. One study compared potassium-magnesium citrate with placebo. Primary outcomes included radiographic evidence (plain radiography, computed tomography, or intravenous urography) of reduced stone size to less than 5 mm, lack of new stone formation, or stone size stability over six months, one year, or two years. Secondary outcomes were the need for retreatment, adverse events, and dropout rates. Dosages of citrate therapy ranged from 30 to 60 mEq per day.

Citrate therapy increased

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Phillips R, Hanchanale VS, Myatt A, Somani B, Nabi G, Biyani CS. Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database Syst Rev. 2015;(10):CD010057....

2. Scales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160–165.

3. Scales CD Jr, Tasian GE, Schwaderer AL, Goldfarb DS, Star RA, Kirkali Z. Urinary stone disease: advancing knowledge, patient care, and population health. Clin J Am Soc Nephrol. 2016;11(7):1305–1312.

4. Barcelo P, Wuhl O, Servitge E, Rousaud A, Pak CY. Randomized double-blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis. J Urol. 1993;150(6):1761–1764.

5. Jiménez Verdejo A, Arrabal Martín M, Miján Ortiz JL, Hita Rosino E, Palao Yago F, Zuluaga Gómez A. Effect of potassium citrate in the prophylaxis of urinary lithiasis [in Spanish]. Arch Esp Urol. 2001;54(9):1036–1046.

6. Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD. Dietary and pharmacologic management to prevent recurrent nephrolithiasis in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(9):659–667.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.

 

 

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