Potassium citrate mixture

PurposeTo evaluate the potential stone-preventative effects of apple cider vinegar (ACV) supplementation on 24-h urinary citrate, pH, and volume.MethodsWe performed a randomized crossover trial testing ACV, coconut water, lemon water, and orange soda. Participants were non-stone formers randomized to two of the four beverages. Participants consumed one assigned beverage daily for one week, underwent a two-week washout period, and then consumed the second assigned beverage. Three 24-h urine collections were planned: one baseline collection prior to beverage consumption, one following completion of the first treatment week, and one following completion of the second week.ResultsTwenty participants were enrolled. Eight were female. Six consumed ACV, six coconut water, eight lemon water, and six diet orange soda. ACV did not significantly change 24-h urinary parameters. Coconut water (+ 273.8 mg/24 h, 95% CI 67.9-480 mg/24 h) and lemon water (+ 167.7 mg/24 h, 95% CI 16-319 mg/24 h) were associated with increased urinary citrate. Effects on urine pH and volume were not significant in any treatment arms.ConclusionACV did not significantly change 24-h urine parameters. Coconut water and lemon water increased urinary citrate. Further study is necessary to validate these findings in a larger cohort. Registered with ClinicalTrials.gov (NCT04073719, 8/28/2019).

Abstract licence: CC BY

BackgroundPotassium citrate (KCit) is commonly prescribed to patients with recurrent nephrolithiasis; however, medication compliance is poor due to gastrointestinal side-effects. Crystal Light® (CL) sugar-free lemonade is a low-calorie beverage alternative that has been shown to increase urinary citrate and pH levels. In this study, we aimed to compare the effects of KCit, CL, and CL + KCit on 24-hour urine collections in hypocitraturic stone formers.MethodsWe performed a randomized crossover trial of 8 patients with isolated hypocitraturia on 24-hour urine collections. Patients completed three 1-week trials of KCit (15 mEq daily), CL (1 L daily), and combination CL and KCit (500 mL + 10 mEq daily) followed by immediate 24-hour urine collections after each weekly treatment. There was a washout period of 1 week in between each regimen. Statistical analysis was conducted with Kruskal-Wallis rank sum tests and linear mixed-effects models.ResultsThe CL regimen led to the greatest increases in urinary volume (CL: 0.53 vs. KCit: -0.08 vs. CL + KCit: 0.21 L, P=0.5) and combination regimen had the greatest increase in urinary citrate (CL: 172 vs. KCit: 68 vs. CL + KCit: 173, P=0.8) from baseline. However, these differences did not reach statistical significance. The CL regimen led to a mean increase in pH of 0.42 compared to 0.25 with CL + KCit and 0.18 with KCit (P=0.6). There were similar increases in supersaturation (SS) of calcium phosphate in all regimens (CL: 0.2 vs. KCit: 0.08 vs. CL + KCit: 0.22, P>0.9). The SS of calcium oxalate (CaOx) decreased by 0.15 in the CL regimen and 1.39 in the KCit regimen but showed slight increases in the combination regimen (0.47, P>0.9). On pairwise comparison after linear mixed effects models were performed, CL resulted in a significantly greater reduction in SS uric acid compared with KCit (mean difference =-0.49, P=0.002).ConclusionsIn this limited study in active stone formers with hypocitraturia, consumption of a low-calorie sugar-free citrate-containing lemonade beverage was well tolerated with no reported adverse effects. Multi-institutional studies are needed to determine clinical significance.Trial registrationClinicalTrials.gov NCT05389995.

Abstract licence: CC BY-NC-ND