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Published on: February 9, 2021

Preventive treatment of nephrolithiasis with alkali citrate--a critical review

D Mattle1, B Hess

  • 1Department of Internal Medicine, Regional Hospital, 3600 Thun, Switzerland.

Urological Research
|May 6, 2005
PubMed

Insights

Alkali citrate treatment effectively reduces kidney stone recurrence and aids stone dissolution. However, a significant number of patients discontinue treatment due to adverse gastrointestinal effects.

Area of Science:

  • Nephrology
  • Urology
  • Pharmacology

Background:

  • Kidney stones (urolithiasis/nephrolithiasis) are a common condition requiring effective preventive and therapeutic strategies.
  • Citrate therapy has been explored for its potential in managing calcium oxalate, uric acid, and infection stones.
  • Evidence synthesis is needed to evaluate the efficacy and tolerability of alkali citrate treatment for kidney stones.

Purpose of the Study:

  • To systematically review and analyze clinical studies on preventive alkali citrate treatment for kidney stones.
  • To assess the effectiveness of alkali citrate in preventing stone recurrence and promoting stone dissolution.
  • To identify the incidence and nature of adverse effects associated with alkali citrate therapy.

Main Methods:

  • A Medline search was conducted using keywords related to urolithiasis, nephrolithiasis, kidney stones, and citrate treatment.
  • Inclusion criteria comprised English/German publications, preventive alkali citrate treatment for specific stone types, clinical studies with ≥10 subjects, and treatment duration of ≥1 week.
  • Forty-three studies meeting criteria were subclassified by endpoints (recurrence, dissolution) and study design (uncontrolled, randomized controlled trials).

Main Results:

  • Uncontrolled studies (n≈1,000) showed a 47-100% reduction in stone formation rate with alkali citrate.
  • Randomized controlled trials (RCTs) demonstrated significantly higher stone-free rates (53.5% vs. 35% placebo) after 1 year (n=227).
  • RCTs focusing on dissolution/clearance showed better outcomes for alkali citrate (66% vs. 27.5% placebo) (n=104), but up to 48% of patients discontinued due to adverse effects (e.g., GI distress).

Conclusions:

  • Preventive alkali citrate treatment is effective in reducing kidney stone recurrence and facilitating stone dissolution.
  • Gastrointestinal side effects are a significant limitation, leading to high dropout rates in patients undergoing citrate therapy.
  • Further research may be warranted to optimize citrate formulations or management strategies to improve patient adherence and tolerability.

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