From the Guidelines
Potassium citrate is the recommended medication to reduce urine acid and increase urinary pH, thereby reducing the risk of uric acid and cystine stones. This is based on the American Urological Association (AUA) guideline, which suggests that clinicians should offer potassium citrate to patients with uric acid and cystine stones to raise urinary pH to an optimal level 1. The goal is to increase urine pH to 6.0 for uric acid stone formers and 7.0 for cystine stone formers. Key points to consider when prescribing potassium citrate include:
- Potassium citrate provides an alkali load that leads to increased urine pH, which increases the solubility of uric acid and cystine
- Potassium citrate is preferred over sodium citrate, as the sodium load in the latter may increase urine calcium excretion 1
- Regular monitoring of kidney function and potassium levels is necessary when taking potassium citrate
- Lifestyle modifications, such as increased fluid intake and dietary changes, may also be beneficial in reducing the risk of kidney stones.
From the FDA Drug Label
The changes induced by Potassium Citrate produce urine that is less conducive to the crystallization of stone-forming salts (calcium oxalate, calcium phosphate and uric acid). Increased citrate in the urine, by complexing with calcium, decreases calcium ion activity and thus the saturation of calcium oxalate Citrate also inhibits the spontaneous nucleation of calcium oxalate and calcium phosphate (brushite).
The medication to reduce urine acr (acidification) is Potassium Citrate. It works by increasing urinary pH and citrate, making the urine less conducive to the crystallization of stone-forming salts.
- Key benefits of Potassium Citrate include:
- Increased urinary citrate
- Increased urinary pH
- Decreased calcium ion activity
- Inhibition of spontaneous nucleation of calcium oxalate and calcium phosphate 2
From the Research
Medication to Reduce Urine Acidity
To reduce urine acidity, several medications and treatments can be considered. The primary goal is to increase the pH of the urine, making it less acidic.
- Potassium citrate is a commonly prescribed medication for this purpose, as it can help increase urine pH and reduce the formation of kidney stones 3, 4, 5, 6, 7.
- The mechanism of action of potassium citrate involves binding to intestinal and urine calcium, increasing urine pH, and reducing calcium excretion by decreasing bone resorption and increasing renal calcium reabsorption 6.
- Potassium citrate has been shown to be effective in reducing the recurrence of kidney stones, particularly those caused by uric acid or calcium phosphate 3, 4, 5.
- In addition to potassium citrate, other treatments such as lemonade supplementation have been studied, but potassium citrate has been found to be more effective in reducing salt and increasing urine pH 7.
- It is essential to monitor urine pH and other parameters when using these treatments to ensure their effectiveness and minimize potential side effects 4, 5, 7.
Potential Side Effects and Interactions
While potassium citrate is generally well-tolerated, potential side effects and interactions should be considered.
- Gastrointestinal upset is a common side effect of potassium citrate, and it may interact with other medications such as allopurinol 5.
- Potassium citrate may also increase urine oxalate and phosphate levels, which could potentially lead to an increased risk of calcium oxalate or calcium phosphate stone formation 6.
- Regular monitoring of urine parameters and adjustment of treatment as needed can help minimize these risks 4, 5, 7.