From the Guidelines
Potassium citrate is the most effective treatment for preventing recurrent calcium stones in patients with low or relatively low urinary citrate, and it should be prescribed at 10-15 mEq twice or three times daily. The use of potassium citrate for urolithiasis is supported by the American Urological Association (AUA) guideline, which recommends offering potassium citrate therapy to patients with recurrent calcium stones and low or relatively low urinary citrate 1. This guideline is based on prospective RCTs that have demonstrated the efficacy of potassium citrate in reducing the risk of recurrent calcium stones.
Key Points
- Potassium citrate is preferred over sodium citrate due to its lower sodium load, which can increase urine calcium excretion 1.
- Rowatinex and sambong may be used as adjunctive treatments for urolithiasis, but their effectiveness is less established compared to potassium citrate.
- Increased fluid intake of at least 2-3 liters daily is recommended to help prevent recurrent nephrolithiasis, as stated in the American College of Physicians (ACP) guideline 2, 3.
- Dietary modifications, such as limiting sodium, animal protein, and oxalate-rich foods, are also important for optimal management of urolithiasis.
Treatment Considerations
- Potassium citrate should be prescribed at 10-15 mEq twice or three times daily for prevention of calcium oxalate and uric acid stones.
- Rowatinex may be used at a dose of 1-2 capsules three times daily during active stone passage, while sambong may be taken as tea or in 500mg capsules 2-3 times daily.
- The choice of treatment should be individualized based on the specific stone type and clinical situation, and patients should be monitored for adverse effects and treatment efficacy.
From the FDA Drug Label
The effect of oral Potassium Citrate therapy in a non-randomized, non-placebo controlled clinical study of five men and four women with calcium oxalate/calcium phosphate nephrolithiasis and documented incomplete distal renal tubular acidosis was examined Potassium Citrate therapy was associated with inhibition of new stone formation in patients with distal tubular acidosis. The stone-passage remission rate was 67%. All patients had a reduced stone formation rate. Over the first 2 years of treatment, the on-treatment stone formation rate was reduced from 13±27 to 1±2 per year.
The efficacy of Potassium Citrate (K citrate) for the treatment of urolithiasis is supported by the studies, which show that it can:
- Inhibit new stone formation in patients with distal tubular acidosis
- Reduce stone formation rate in all patients
- Increase urinary citrate excretion and urinary pH
However, there is no information in the provided drug labels about the efficacy of Rowatinex (Phenylbutazone) and Sambong (Blumea balsamifera) for the treatment of urolithiasis. Therefore, no conclusion can be drawn about the efficacy of these two treatments. The FDA drug label does not answer the question for Rowatinex and Sambong. For Potassium Citrate, the evidence suggests it is effective in reducing stone formation and increasing urinary citrate and pH levels 4.
From the Research
Efficacy of Rowatinex (Phenylbutazone), Sambong (Blumea balsamifera), and Potassium Citrate (K citrate) for Urolithiasis Treatment
- There is no available evidence regarding the efficacy of Rowatinex (Phenylbutazone) and Sambong (Blumea balsamifera) for the treatment of urolithiasis.
- Potassium citrate (K citrate) has been shown to be effective in preventing the recurrence of nephrolithiasis: + A meta-analysis found that citrate supplement significantly protected against the recurrence of nephrolithiasis during 1 year after SWL 5. + Clinical and in vitro data suggest that increasing urine citrate levels will decrease the precipitation of calcium stones 6. + The oral administration of potassium citrate has been found to reduce the incidence of calcium oxalate stone formation in the urinary tract 7. + Citrate therapy has been used in the medical and surgical treatment of urolithiasis, and its mechanism of action and indications have been studied 8. + Alkaline citrate has been found to reduce stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy 9.
Key Findings
- Potassium citrate supplement reduces the recurrence of nephrolithiasis in patients undergoing SWL 5.
- Increasing urine citrate levels decreases the precipitation of calcium stones 6.
- Citrate ions prevent stone formation by inhibiting the crystallisation of calcium oxalate 7.
- Citrate therapy is used in the treatment of urolithiasis, but its mechanism of action and indications need to be further understood 8.
- Alkaline citrate reduces stone recurrence and regrowth after ESWL and PCNL procedures 9.