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

Abstract

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

CUA Guideline: Management of ureteral calculi

“…138,[142][143][144] Management of ureteral calculi When these agents are given to patients after ESWL or PCNL, they facilitate the dissolution of residual stones <4 mm and prevent stone re-growth and recurrence. 145 In addition, the combination of alpha blockers (such as tamsulosin) and potassium citrate have been associated with significantly higher stone-free rates when compared with either therapy alone or with placebo in patients with distal ureteric UA stones (84.4%, 68.8%, 58.7%, and 26.1%, respectively). 146 Although UA stones are easy to fragment by SWL, they are difficult to localize due to their radiolucency.…”

Effect of Potassium Citrate on Calcium Phosphate Stones in a Model of Hypercalciuria

“…In a randomized controlled study, potassium and sodium citrate appeared to reduce the risk of stone recurrence after extracorporeal shockwave lithotripsy or percutaneous nephrolithotomy. 20 In another randomized controlled study, K-cit appeared effective in reducing lower caliceal calculi after shockwave lithotripsy. 21 Neither of these studies was placebo controlled.…”

CUA guideline on the evaluation and medical management of the kidney stone patient ‒ 2016 update

“…Alkali citrate results in a significant increase in urinary pH and urinary citrate and decreases recurrent nephrolithiasis. [99][100][101][102][103][104][105][106][107] Potassium citrate is the most commonly studied agent, with dosages in clinical trials ranging from 30-60 mEq in divided doses daily. Given the risk of calcium phosphate stone formation with the use of citrate, careful monitoring of urine pH is recommended.…”