Potassium citrate decreases urine calcium excretion in patients with hypocitraturic calcium oxalate nephrolithiasis

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• 作者：Yan Song ; Natalia Hernandez ; Jonathan Shoag ; David S. Goldfarb…
• 关键词：Kidney stone ; Potassium citrate ; Urine calcium
• 刊名：Urological Research
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：44
• 期：2
• 页码：145-148
• 全文大小：371 KB
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• 作者单位：Yan Song (1)
  Natalia Hernandez (2)
  Jonathan Shoag (3)
  David S. Goldfarb (4)
  Brian H. Eisner (2)
  
  1. Department of Urology, ShengJing Hospital of China, Medical University, Shenyang, 110004, Liaoning, People’s Republic of China
  2. Department of Urology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
  3. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
  4. New York University Langone Medical Center Section of Nephrology, New York Harbor Veterans Affairs Healthcare System, New York, NY, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Urology and Andrology
  Nephrology
  Medical Biochemistry
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-0879

文摘

Two previous studies (<10 patients each) have demonstrated that alkali therapy may reduce urine calcium excretion in patients with calcium oxalate nephrolithiasis. The hypothesized mechanisms are (1) a decrease in bone turnover due to systemic alkalinization by the medications; (2) binding of calcium by citrate in the gastrointestinal tract; (3) direct effects on TRPV5 activity in the distal tubule. We performed a retrospective review of patients on potassium citrate therapy to evaluate the effects of this medication on urinary calcium excretion. A retrospective review was performed of a metabolic stone database at a tertiary care academic hospital. Patients were identified with a history of calcium oxalate nephrolithiasis and hypocitraturia who were on potassium citrate therapy for a minimum of 3 months. 24-h urine composition was assessed prior to the initiation of potassium citrate therapy and after 3 months of therapy. Patients received 30–60 mEq potassium citrate by mouth daily. Inclusion criterion was a change in urine potassium of 20 mEq/day or greater, which suggests compliance with potassium citrate therapy. Paired t test was used to compare therapeutic effect. Twenty-two patients were evaluated. Mean age was 58.8 years (SD 14.0), mean BMI was 29.6 kg/m2 (SD 5.9), and gender prevalence was 36.4 % female:63.6 % male. Mean pre-treatment 24-h urine values were as follows: citrate 280.0 mg/day, potassium 58.7 mEq/day, calcium 216.0 mg/day, pH 5.87. Potassium citrate therapy was associated with statistically significant changes in each of these parameters—citrate increased to 548.4 mg/day (p < 0.0001), potassium increased to 94.1 mEq/day (p < 0.0001), calcium decreased to 156.5 mg/day (p = 0.04), pH increased to 6.47 (p = 0.001). Urine sodium excretion was not different pre- and post-therapy (175 mEq/day pre-therapy versus 201 mEq/day post-therapy, p = NS). Urinary calcium excretion decreased by a mean of 60 mg/day on potassium citrate therapy—a nearly 30 % decrease in urine calcium excretion. These data lend support to the hypothesis that alkali therapy reduces urine calcium excretion.