Strategy to control catheter encrustation with citrated drinks: a randomized crossover study

Area of Science:

• Urology
• Biochemistry
• Materials Science

Background:

• Catheter encrustation, a common complication, is linked to crystal formation in urine.
• Controlling urease-producing bacteria is a current strategy to prevent encrustation.
• Increasing the safety margin between voiding and nucleation pH is a potential alternative strategy.

Purpose of the Study:

• To evaluate the efficacy of increased fluid intake, lemon juice, and potassium citrate in managing catheter encrustation.
• To determine the impact of these interventions on nucleation pH and urinary citrate levels.
• To assess the potential of these strategies as alternatives to antibacterial control for catheter encrustation.

Main Methods:

• A 6-week randomized crossover study involving 24 patients with a history of catheter blockage.
• Patients received three consecutive treatments: increased fluid intake, lemon juice, and potassium citrate.
• Urine samples were analyzed weekly for voiding pH, nucleation pH, citrate, calcium (Ca), and magnesium (Mg).

Main Results:

• Nucleation pH significantly increased across all treatment groups (p <0.0001).
• Urinary citrate levels increased significantly, particularly with lemon juice and potassium citrate (p <0.0001).
• The safety margin (nucleation pH minus voiding pH) showed a notable increase, with lemon juice demonstrating the largest average increase (0.84).

Conclusions:

• Increased fluid intake combined with lemon juice presents a simple, cost-effective, and effective method for controlling catheter encrustation.
• This strategy offers a promising alternative to managing urease-producing bacteria for preventing catheter-related complications.
• The findings support the use of dietary modifications to improve urinary conditions and prevent device-associated issues.