Effect of citrus-based products on urine profile: A systematic review and meta-analysis

Abstract

Background . Urolithiasis is a disease with high recurrence rate, 30-50% within 5 years. The aim of the present study was to learn the effects of citrus-based products on the urine profile in healthy persons and people with urolithiasis compared to control diet and potassium citrate. Methods. A systematic review was performed, which included interventional, prospective observational and retrospective studies, comparing citrus-based therapy with standard diet therapy, mineral water, or potassium citrate. A literature search was conducted using PUBMED, COCHRANE, and Google Scholar with “citrus or lemonade or orange or grapefruit or lime or juice” and “urolithiasis” as search terms. For statistical analysis, a fixed-effects model was conducted when p > 0.05, and random-effects model was conducted when p < 0.05. Results. In total, 135 citations were found through database searching with 10 studies found to be consistent with our selection criteria. However, only 8 studies were included in quantitative analysis, due to data availability. The present study showed a higher increased in urine pH for citrus-based products (mean difference, 0.16; 95% CI 0.01-0.32) and urinary citrate (mean difference, 124.49; 95% CI 80.24-168.74) compared with a control group. However, no differences were found in urine volume, urinary calcium, urinary oxalate, and urinary uric acid. From subgroup analysis, we found that citrus-based products consistently increased urinary citrate level higher than controls in both healthy and urolithiasis populations. Furthermore, there was lower urinary calcium level among people with urolithiasis. Conclusions. Citrus-based products could increase urinary citrate level significantly higher than control. These results should encourage further research to explore citrus-based products as a urolithiasis treatment.

Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study

“…Potassium citrate binds with sodium in urine and decreases sodium level in urine, increases pH of urine, and ultimately reduces stone formation [ 21 ]. These results were in line with available studies [ 11 , 12 , 20 ]. Potassium citrate is effective in treatment of pediatric urolithiasis.…”

“…A high fluid intake prevents caliceal stones formation by decreasing supersaturation and citrate prevents caliceal stones formation by ionization of urinary calcium [ 10 ]. Lemons, oranges, and grapes are recommended in pediatric urolithiasis [ 11 , 12 ]. Lemonade has 110 mg/kg calcium and 490 g/kg citric acid.…”

Maternal and Congenital Toxoplasmosis: Diagnosis and Treatment Recommendations of a French Multidisciplinary Working Group

“…In case of treatment by pyrimethamine–sulfamide, supplementation with folinic acid is required (folic acid is not effective). Women should be instructed to drink at least 2 L per 24 h and to alkalinize the urine (for instance, by consuming citrus-based products [21]).…”

Lime powder regimen supplement alleviates urinary metabolic abnormalities in urolithiasis patients

“…Previous studies revealed that natural lime juice or lemonade could not increase urinary pH because it was rich in citric acid, not citrate form . However, LPR contained higher concentration of citrate and potassium, which potentially elevated urinary pH . We assumed that the elevation of urinary pH observed in LPR group was the result of citrate and potassium supplement, and LPR can directly increase urinary citrate and potassium excretion and indirectly by elevate urinary pH and alleviate metabolic acidosis.…”