AUA 2019: Dietary Alternatives to Prescription Potassium Citrate

Chicago, IL ( Dr. Tim Large, from Indiana University, presented research evaluating low-calorie dietary alternatives to the commonly prescribed Potassium Citrate for the treatment of patients with uric acid or cystine stones, recurrent calcium stones, and those with low or relatively low urinary citrate. Though AUA guidelines state that potassium citrate should be started for patients with these issues, many patients have noted gastrointestinal side effects and complain of the high frequency of dosing, the high cost, and the large pill size. The authors, therefore, aimed to identify a low-calorie beverage that could adequately alkalinize human urine.

The researchers initially tested multiple orange and lemon-based beverages with ion chromatography to discover more natural dietary sources of alkali and citrate. The drinks with the higher sources of alkali and citrate, Tropicana 50 and Kroger lite orange juice, were then compared to crystal light lemonade. Each of the beverages was prospectively randomized to 10 participants over a total of 8 weeks. During that time, each volunteer consumed 2L of H2O for 7 days, 1L of Tropicana 50 or Kroger lite orange juice with 1L of H2O for 7 days, and 1L of crystal lite lemonade with 1L of H20 for 7 days. After each 7 day week, a 24hr urine collection analyzed by Litholink was obtained.

Ion chromatography revealed the high concentration of alkali and citrate within the three stated drinks. Compared to the control week of 2L/water/day, the patients during the week period of Tropicana 50 and Kroger lite orange juice as well as the week of crystal light lemonade had increased urine production. The Kroger lite orange juice also increased the urinary pH significantly more compared to Crystal light lemonade and Tropicana 50. While Tropicana 50 did increase the urinary pH, the volunteers reported increased GI discomfort and dyspepsia which the researchers attributed to Stevia, the artificial sweetener.

In conclusion, Tropicana 50, Kroger lite orange juice, and crystal light lemonade all raise the urinary pH and citrate levels. However, Tropicana 50 could cause many of the GI symptoms that patients complain of with potassium citrate. The authors stated that this study was not to find an alternative to potassium citrate but instead to have the beverages to supplement potassium citrate. This would, therefore, allow patients to decrease their potassium citrate dosage and alleviate most patient complaints regarding the use of potassium citrate supplementation.

Presented by: Tim Large, MD, Urologist, Indiana University School of Medicine, Indianapolis, Indiana, United States 

Written by: Vinay Cooper, (Department of Urology, University of California-Irvine medical writer for at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois