alkali citrate

Alkaline citrate can be prescribed (K-citrate) or found as an over-the-counter (OTC) pill, liquid, or powder. For kidney stone prevention or alkalinization, it is most often accompanied by mineral(s) sodium or potassium. Less frequently, magnesium citrate may be included. This results in compounds like Trimagnesium citrate,{{Cite journal |last1=Schwille |first1=P. O. |last2=Schmiedl |first2=A. |last3=Herrmann |first3=U. |last4=Fan |first4=J. |last5=Gottlieb |first5=D. |last6=Manoharan |first6=M. |last7=Wipplinger |first7=J. |date=1999-05-01 |title=Magnesium, citrate, magnesium citrate and magnesium-alkali citrate as modulators of calcium oxalate crystallization in urine: observations in patients with recurrent idiopathic calcium urolithiasis |url=https://doi.org/10.1007/s002400050097 |journal=Urological Research |language=en |volume=27 |issue=2 |pages=117–126 |doi=10.1007/s002400050097 |pmid=10424393 |s2cid=1506052 |issn=1434-0879|url-access=subscription }} Tripotassium citrate{{Cite journal |last1=Wong |first1=Daniel G. |last2=Elson |first2=Lauren |last3=Nottingham |first3=Charles U. |last4=Desai |first4=Alana C. |date=2022-05-01 |title=Pharmaceutical versus Over-the-Counter Potassium Citrate: A Benchtop Comparison |url=https://www.auajournals.org/doi/10.1097/UPJ.0000000000000300 |journal=Urology Practice |volume=9 |issue=3 |pages=205–211 |doi=10.1097/UPJ.0000000000000300|s2cid=246716306 |url-access=subscription }}{{Cite web |title=The Impact of Alternative Alkalinizing Agents on 24-Hour Urine Parameters |url=https://urology.wisc.edu/wp-content/uploads/2021/01/boydston-alternative-alkali-kcit.pdf |website=University of Wisconsin Department of Urology}}{{Cite book |last=Rao |first=Nagarja |title=Urinary Tract Stone Disease |publisher=Springer London |year=2011 |isbn=9781848003620 |pages=183}} and Trisodium citrate:{{Cite web |last=PubChem |title=Sodium citrate |url=https://pubchem.ncbi.nlm.nih.gov/compound/6224 |access-date=2022-08-24 |website=pubchem.ncbi.nlm.nih.gov |language=en}}

• Potassium citrate: K₃C₆H₅O₇ or C₆H₅K₃O₇{{Cite web |last=PubChem |title=Potassium citrate |url=https://pubchem.ncbi.nlm.nih.gov/compound/13344 |access-date=2022-08-24 |website=pubchem.ncbi.nlm.nih.gov |language=en}}
• Trisodium citrate: C₆H₅Na₃O₇
• Magnesium citrate: C₁₂H₁₀Mg₃O₁₄{{Cite web |last=PubChem |title=Magnesium citrate |url=https://pubchem.ncbi.nlm.nih.gov/compound/6099959 |access-date=2022-08-24 |website=pubchem.ncbi.nlm.nih.gov |language=en}}

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.{{Cite journal |last1=Goodman |first1=Jeffrey W. |last2=Asplin |first2=John R. |last3=Goldfarb |first3=David S. |date=2009 |title=Effect of two sports drinks on urinary lithogenicity |url=https://pubmed.ncbi.nlm.nih.gov/19066876/ |journal=Urological Research |volume=37 |issue=1 |pages=41–46 |doi=10.1007/s00240-008-0166-0 |issn=1434-0879 |pmid=19066876|s2cid=24253323 }}

Alkaline citrates are used to prevent recurrent calcium stone formation.{{Cite journal |last1=Hauser |first1=W. |last2=Frick |first2=J. |last3=Kunit |first3=G. |date=1990 |title=Alkali citrate for preventing recurrence of calcium oxalate stones |url=https://pubmed.ncbi.nlm.nih.gov/2190842/ |journal=European Urology |volume=17 |issue=3 |pages=248–251 |doi=10.1159/000464049 |issn=0302-2838 |pmid=2190842}}{{Cite journal |last1=Berg |first1=Clas |last2=Larsson |first2=Lasse |last3=Tiselius |first3=Hans-Göran |date=1992-09-01 |title=The Effects of a Single Evening Dose of Alkaline Citrate on Urine Composition and Calcium Stone Formation |url=https://www.sciencedirect.com/science/article/pii/S0022534717367952 |journal=The Journal of Urology |language=en |volume=148 |issue=3, Part 2 |pages=979–985 |doi=10.1016/S0022-5347(17)36795-2 |pmid=1507355 |issn=0022-5347|url-access=subscription }}{{Cite journal |last1=Achilles |first1=W. |last2=Schulze |first2=D. |last3=Schalk |first3=C. |last4=Rodeck |first4=G. |date=1990 |title=The in-vivo effect of sodium-potassium citrate on the crystal growth rate of calcium oxalate and other parameters in human urine |url=https://pubmed.ncbi.nlm.nih.gov/2316065/ |journal=Urological Research |volume=18 |issue=1 |pages=1–6 |doi=10.1007/BF00294572 |issn=0300-5623 |pmid=2316065|s2cid=27047307 }} This is one of the major types of kidney stones.{{Cite journal |title=Citrate salts for preventing and treating calcium containing kidney stones in adults |url=https://www.cochrane.org/CD010057/RENAL_citrate-salts-preventing-and-treating-calcium-containing-kidney-stones-adults |access-date=2022-08-24 |journal=Cochrane Database of Systematic Reviews |year=2015 |doi=10.1002/14651858.CD010057.pub2 |language=en|last1=Phillips |first1=Rebecca |last2=Hanchanale |first2=Vishwanath S. |last3=Myatt |first3=Andy |last4=Somani |first4=Bhaskar |last5=Nabi |first5=Ghulam |last6=Biyani |first6=C Shekhar |volume=2015 |issue=10 |pages=CD010057 |pmid=26439475 |pmc=9578669 }}{{Cite web |last=MBA |first=Kevin R. Loughlin, MD |date=2019-05-17 |title=What causes kidney stones (and what to do) |url=https://www.health.harvard.edu/blog/what-causes-kidney-stones-and-what-to-do-2019051716656 |access-date=2022-08-24 |website=Harvard Health |language=en}} The citrate salts can increase urine citrate, which binds with urine calcium, reduces supersaturation of calcium salts, and inhibits crystal formation.{{Cite web |title=CITRATE TO PREVENT CALCIUM AND URIC ACID STONES {{!}} Kidney Stone Evaluation And Treatment Program |url=https://kidneystones.uchicago.edu/citrate-to-prevent-stones/ |access-date=2022-08-24 |website=kidneystones.uchicago.edu |language=en-US}} This helps prevent kidney stones.

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.”{{Cite journal |last1=Navaneethan |first1=Sankar D. |last2=Shao |first2=Jun |last3=Buysse |first3=Jerry |last4=Bushinsky |first4=David A. |date=2019-07-05 |title=Effects of Treatment of Metabolic Acidosis in CKD |journal=Clinical Journal of the American Society of Nephrology |volume=14 |issue=7 |pages=1011–1020 |doi=10.2215/CJN.13091118 |issn=1555-9041 |pmc=6625635 |pmid=31196951}}

The compound also raises urine pH. 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.

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Category:Citrates