Alkali citrate

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Alkali citrate (also known as alkaline citrate) is an inhibitor of kidney stones. [1] It is used to increase urine citrate levels - this prevents calcium oxalate stones by binding to calcium and inhibiting its binding to oxalate. [2] It is also used to increase urine pH (alkalinize urine) - this prevents uric acid stones and cystine stones (which form in cystinuria). [2]

Contents

It is different than citric acid which is citrate bonded by hydrogen ions (or protons) making it acidic. [3] Citric acid does not alkalinize urine as alkali citrate does. [4] Alkali citrate replaces the protons with a non-acid positively charged ion like sodium, potassium or magnesium.

Available forms

Alkaline citrate can be prescribed (K-citrate) or found as an over-the-counter (OTC) pill, liquid, or powder. [2] For kidney stone prevention or alkalinization, it is most often accompanied by mineral(s) sodium or potassium. Less frequently, magnesium citrate may be included. [2] This results in compounds like Trimagnesium citrate, [5] Tripotassium citrate [6] [7] [8] and Trisodium citrate: [9]

Citrus based beverages like lemon juice and orange juice may raise urine citrate, but much of the citrate is citric acid; without a cation like sodium, potassium or magnesium these beverages will have less effect on urine chemistry and therefore not aid in prevention of kidney stones as alkali citrate will. [12]

Biological effects

Alkaline citrates are used to prevent recurrent calcium stone formation. [13] [14] [15] [5] This is one of the major types of kidney stones. [16] [17] The citrate salts can increase urine citrate, which binds with urine calcium, reduces supersaturation of calcium salts, and inhibits crystal formation. [18] [8] This helps prevent kidney stones. [18] [8]

Oral alkali supplementation can also slow the rate of kidney function decline and “potentially reduce the risk of end stage kidney disease (ESKD) in patients with chronic kidney disease (CKD) and metabolic acidosis.” [19]

The compound also raises urine pH. [18] When citrate is metabolized by the liver, it essentially generates bicarbonate, an important buffer. This reduces uric acid supersaturation and prevents uric acid stones and cystine stones. [18] [8]

Related Research Articles

<span class="mw-page-title-main">Kidney stone disease</span> Formation of mineral stones in the urinary tract

Kidney stone disease, also known as nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material develops in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine stream. A small stone may pass without causing symptoms. If a stone grows to more than 5 millimeters, it can cause blockage of the ureter, resulting in sharp and severe pain in the lower back or abdomen. A stone may also result in blood in the urine, vomiting, or painful urination. About half of people who have had a kidney stone will have another within ten years.

<span class="mw-page-title-main">Citric acid</span> Weak organic acid

Citric acid is an organic compound with the chemical formula HOC(CO2H)(CH2CO2H)2. It is a colorless weak organic acid. It occurs naturally in citrus fruits. In biochemistry, it is an intermediate in the citric acid cycle, which occurs in the metabolism of all aerobic organisms.

<span class="mw-page-title-main">Calcium oxalate</span> Calcium compound

Calcium oxalate (in archaic terminology, oxalate of lime) is a calcium salt of oxalic acid with the chemical formula CaC2O4. It forms hydrates CaC2O4·nH2O, where n varies from 1 to 3. Anhydrous and all hydrated forms are colorless or white. The monohydrate CaC2O4·H2O occurs naturally as the mineral whewellite, forming envelope-shaped crystals, known in plants as raphides. The two rarer hydrates are dihydrate CaC2O4·2H2O, which occurs naturally as the mineral weddellite, and trihydrate CaC2O4·3H2O, which occurs naturally as the mineral caoxite, are also recognized. Some foods have high quantities of calcium oxalates and can produce sores and numbing on ingestion and may even be fatal. Tribes with diets that depend highly on fruits and vegetables high in calcium oxalate, such as in Micronesia, reduce the level of it by boiling and cooking them. They are a constituent in 76% of human kidney stones. Calcium oxalate is also found in beerstone, a scale that forms on containers used in breweries.

<span class="mw-page-title-main">Bladder stone</span> Concretion of material in the urinary bladder

A bladder stone is a stone found in the urinary bladder.

<span class="mw-page-title-main">Oxalate</span> Any derivative of oxalic acid; chemical compound containing oxalate moiety

Oxalate (IUPAC: ethanedioate) is an anion with the formula C2O42−. This dianion is colorless. It occurs naturally, including in some foods. It forms a variety of salts, for example sodium oxalate (Na2C2O4), and several esters such as dimethyl oxalate (C2O4(CH3)2). It is a conjugate base of oxalic acid. At neutral pH in aqueous solution, oxalic acid converts completely to oxalate.

Tumor lysis syndrome (TLS) is a group of metabolic abnormalities that can occur as a complication from the treatment of cancer, where large amounts of tumor cells are killed off (lysed) from the treatment, releasing their contents into the bloodstream. This occurs most commonly after the treatment of lymphomas and leukemias and in particular when treating non-Hodgkin lymphoma, acute myeloid leukemia, and acute lymphoblastic leukemia. This is a potentially fatal complication and patients at increased risk for TLS should be closely monitored while receiving chemotherapy and should receive preventive measures and treatments as necessary. TLS can also occur on its own although this is less common.

<span class="mw-page-title-main">Chlortalidone</span> Thiazide-like diuretic drug

Chlortalidone, also known as chlorthalidone, is a thiazide-like diuretic drug used to treat high blood pressure, swelling including that due to heart failure, liver failure, and nephrotic syndrome, diabetes insipidus, and renal tubular acidosis. Because chlortalidone is reliably effective in most patients with high blood pressure, it is considered a preferred initial treatment. It is also used to prevent calcium-based kidney stones. It is taken by mouth. Effects generally begin within three hours and last for up to three days. Chlortalidone is more effective than hydrochlorothiazide for prevention of heart attack or stroke.

<span class="mw-page-title-main">Thiazide</span> Class of chemical compounds

Thiazide refers to both a class of sulfur-containing organic molecules and a class of diuretics based on the chemical structure of benzothiadiazine. The thiazide drug class was discovered and developed at Merck and Co. in the 1950s. The first approved drug of this class, chlorothiazide, was marketed under the trade name Diuril beginning in 1958. In most countries, thiazides are the least expensive antihypertensive drugs available.

<span class="mw-page-title-main">Potassium citrate</span> Chemical compound

Potassium citrate (also known as tripotassium citrate) is a potassium salt of citric acid with the molecular formula K3C6H5O7. It is a white, hygroscopic crystalline powder. It is odorless with a saline taste. It contains 38.28% potassium by mass. In the monohydrate form, it is highly hygroscopic and deliquescent.

<span class="mw-page-title-main">Sodium oxalate</span> Chemical compound

Sodium oxalate, or disodium oxalate, is the sodium salt of oxalic acid with the formula Na2C2O4. It is a white, crystalline, odorless solid, that decomposes above 290 °C.

<span class="mw-page-title-main">Bladder stone (animal)</span>

Bladder stones or uroliths are a common occurrence in animals, especially in domestic animals such as dogs and cats. Occurrence in other species, including tortoises, has been reported as well. The stones form in the urinary bladder in varying size and numbers secondary to infection, dietary influences, and genetics. Stones can form in any part of the urinary tract in dogs and cats, but unlike in humans, stones of the kidney are less common and do not often cause significant disease, although they can contribute to pyelonephritis and chronic kidney disease. Types of stones include struvite, calcium oxalate, urate, cystine, calcium phosphate, and silicate. Struvite and calcium oxalate stones are by far the most common. Bladder stones are not the same as bladder crystals but if the crystals coalesce unchecked in the bladder they can become stones.

<span class="mw-page-title-main">Monosodium citrate</span> Chemical compound

Monosodium citrate, more correctly, sodium dihydrogen citrate (Latin: natrium citricum acidulatum), is an acid salt of citric acid. Disodium citrate and trisodium citrate are also known. It can be prepared by partial neutralisation of citric acid with an aqueous solution of sodium bicarbonate or carbonate. It has a slightly acidic taste.

<span class="mw-page-title-main">Dicalcium citrate</span> Chemical compound

Dicalcium citrate is a compound with formula C6H6Ca2O7. It is a calcium acid salt of citric acid.

<span class="mw-page-title-main">Magnesium citrate</span> Chemical compound

Magnesium citrate is a magnesium preparation in salt form with citric acid in a 1:1 ratio. The name "magnesium citrate" is ambiguous and sometimes may refer to other salts such as trimagnesium citrate which has a magnesium:citrate ratio of 3:2.

Sodium citrate may refer to any of the sodium salts of citric acid :

Sodium cellulose phosphate is a drug used to treat hypercalcemia and hypercalciuria. It has been used to prevent kidney stones.

<span class="mw-page-title-main">Distal renal tubular acidosis</span> Medical condition

Distal renal tubular acidosis (dRTA) is the classical form of RTA, being the first described. Distal RTA is characterized by a failure of acid secretion by the alpha intercalated cells of the distal tubule and cortical collecting duct of the distal nephron. This failure of acid secretion may be due to a number of causes. It leads to relatively alkaline urine, due to the kidney's inability to acidify the urine to a pH of less than 5.3.

<span class="mw-page-title-main">Renal stone formation in space</span>

Renal stone formation and passage during space flight can potentially pose a severe risk to crew member health and safety and could affect mission outcome. Although renal stones are routinely and successfully treated on Earth, the occurrence of these during space flight can prove to be problematic.

<span class="mw-page-title-main">Idiopathic hypercalcinuria</span>

Idiopathic hypercalcinuria (IH) is a condition including an excessive urinary calcium level with a normal blood calcium level resulting from no underlying cause. IH has become the most common cause of hypercalciuria and is the most serious metabolic risk factor for developing nephrolithiasis. IH can predispose individuals to osteopenia or osteoporosis, and affects the entire body. IH arises due to faulty calcium homeostasis, a closely monitored process, where slight deviations in calcium transport in the intestines, blood, and bone can lead to excessive calcium excretion, bone mineral density loss, or kidney stone formation. 50%-60% of nephrolithiasis patients suffer from IH and have 5%-15% lower bone density than those who do not.

References

  1. ↑ Berg, C.; Larsson, L.; Tiselius, H. G. (1992). "The effects of a single evening dose of alkaline citrate on urine composition and calcium stone formation". The Journal of Urology. 148 (3 Pt 2): 979–985. doi:10.1016/s0022-5347(17)36795-2. ISSN   0022-5347. PMID   1507355.
  2. 1 2 3 4 "Educate Your Patients about Kidney Stones" (PDF). National Kidney Foundation.
  3. ↑ PubChem. "Citric acid". pubchem.ncbi.nlm.nih.gov. Retrieved 2022-08-24.
  4. ↑ "Citric Acid and Kidney Stones" (PDF). UW Health.
  5. 1 2 Schwille, P. O.; Schmiedl, A.; Herrmann, U.; Fan, J.; Gottlieb, D.; Manoharan, M.; Wipplinger, J. (1999-05-01). "Magnesium, citrate, magnesium citrate and magnesium-alkali citrate as modulators of calcium oxalate crystallization in urine: observations in patients with recurrent idiopathic calcium urolithiasis". Urological Research. 27 (2): 117–126. doi:10.1007/s002400050097. ISSN   1434-0879. PMID   10424393. S2CID   1506052.
  6. ↑ Wong, Daniel G.; Elson, Lauren; Nottingham, Charles U.; Desai, Alana C. (2022-05-01). "Pharmaceutical versus Over-the-Counter Potassium Citrate: A Benchtop Comparison". Urology Practice. 9 (3): 205–211. doi:10.1097/UPJ.0000000000000300. S2CID   246716306.
  7. ↑ "The Impact of Alternative Alkalinizing Agents on 24-Hour Urine Parameters" (PDF). University of Wisconsin Department of Urology.
  8. 1 2 3 4 Rao, Nagarja (2011). Urinary Tract Stone Disease. Springer London. p. 183. ISBN   9781848003620.
  9. 1 2 PubChem. "Sodium citrate". pubchem.ncbi.nlm.nih.gov. Retrieved 2022-08-24.
  10. ↑ PubChem. "Potassium citrate". pubchem.ncbi.nlm.nih.gov. Retrieved 2022-08-24.
  11. ↑ PubChem. "Magnesium citrate". pubchem.ncbi.nlm.nih.gov. Retrieved 2022-08-24.
  12. ↑ Goodman, Jeffrey W.; Asplin, John R.; Goldfarb, David S. (2009). "Effect of two sports drinks on urinary lithogenicity". Urological Research. 37 (1): 41–46. doi:10.1007/s00240-008-0166-0. ISSN   1434-0879. PMID   19066876. S2CID   24253323.
  13. ↑ Hauser, W.; Frick, J.; Kunit, G. (1990). "Alkali citrate for preventing recurrence of calcium oxalate stones". European Urology. 17 (3): 248–251. doi:10.1159/000464049. ISSN   0302-2838. PMID   2190842.
  14. ↑ Berg, Clas; Larsson, Lasse; Tiselius, Hans-Göran (1992-09-01). "The Effects of a Single Evening Dose of Alkaline Citrate on Urine Composition and Calcium Stone Formation". The Journal of Urology. 148 (3, Part 2): 979–985. doi:10.1016/S0022-5347(17)36795-2. ISSN   0022-5347. PMID   1507355.
  15. ↑ Achilles, W.; Schulze, D.; Schalk, C.; Rodeck, G. (1990). "The in-vivo effect of sodium-potassium citrate on the crystal growth rate of calcium oxalate and other parameters in human urine". Urological Research. 18 (1): 1–6. doi:10.1007/BF00294572. ISSN   0300-5623. PMID   2316065. S2CID   27047307.
  16. ↑ Phillips, Rebecca; Hanchanale, Vishwanath S.; Myatt, Andy; Somani, Bhaskar; Nabi, Ghulam; Biyani, C Shekhar (2015). "Citrate salts for preventing and treating calcium containing kidney stones in adults". Cochrane Database of Systematic Reviews. 2015 (10): CD010057. doi:10.1002/14651858.CD010057.pub2. PMC   9578669 . PMID   26439475 . Retrieved 2022-08-24.
  17. ↑ MBA, Kevin R. Loughlin, MD (2019-05-17). "What causes kidney stones (and what to do)". Harvard Health. Retrieved 2022-08-24.
  18. 1 2 3 4 "CITRATE TO PREVENT CALCIUM AND URIC ACID STONES | Kidney Stone Evaluation And Treatment Program". kidneystones.uchicago.edu. Retrieved 2022-08-24.
  19. ↑ Navaneethan, Sankar D.; Shao, Jun; Buysse, Jerry; Bushinsky, David A. (2019-07-05). "Effects of Treatment of Metabolic Acidosis in CKD". Clinical Journal of the American Society of Nephrology. 14 (7): 1011–1020. doi:10.2215/CJN.13091118. ISSN   1555-9041. PMC   6625635 . PMID   31196951.
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