Potassium citrate and calcium stones: Benefit or risk?
Nephrolithiasis is a common urological disease that will affect 5-10∈% of adults during their lifetime. The natural history of nephrolithiasis is characterized by recurrence, with almost 50∈% of patients recurring within 5 years of their initial stone event. Each stone episode can cause significant pain, decreases productivity, and, if not treated appropriately, may lead to renal dysfunction. Medical therapy has been used for many years in the prevention of stone growth/recurrence. Potassium citrate is an oral alkalizing agent that has been used as the mainstay of medical nephrolithiasis management in the last three decades. With the recent increase in calcium-phosphate stone formation, concern has been raised that potassium citrate may be contributing to this finding. In this chapter, we will highlight the contemporary use of potassium citrate in the clinical management of nephrolithiasis. The mechanisms of action and physicochemical changes that can be achieved by potassium citrate will be elaborated. Clinical trials demonstrating the efficacy of potassium citrate will be reviewed. Overall benefits and possible risks of potassium-citrate treatment will be provided.
