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Citrate salts for preventing and treating calcium containing kidney stones in adults

Citrate salts for preventing and treating calcium containing kidney stones in adults
Citrate salts for preventing and treating calcium containing kidney stones in adults

Background: kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain.

Objectives: the objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones.

Search methods: we searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.

Selection criteria: we included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months.

Data collection and analysis: two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.

Main results: we included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89).

Author's conclusions: nitrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.

Adult, Calcium Oxalate, Calcium Phosphates, Citrates, Drug Combinations, Humans, Kidney Calculi, Magnesium Compounds, Potassium Compounds, Randomized Controlled Trials as Topic, Recurrence, Secondary Prevention, Journal Article, Meta-Analysis, Review
1469-493X
CD010057
Phillips, Rebecca
e491b2ef-92c8-4bdc-914c-e3c175ea1bd7
Hanchanale, Vishwanath S
22cd57fb-779e-4fcf-a850-53da7239cb53
Myatt, Andy
7823bdeb-b523-4355-9c1a-f5aacac613d4
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Nabi, Ghulam
20d3e635-ec9c-4b53-8703-f50b443196da
Biyani, C Shekhar
2d96e24e-f3f3-4ba5-8258-73ba26f63321
Phillips, Rebecca
e491b2ef-92c8-4bdc-914c-e3c175ea1bd7
Hanchanale, Vishwanath S
22cd57fb-779e-4fcf-a850-53da7239cb53
Myatt, Andy
7823bdeb-b523-4355-9c1a-f5aacac613d4
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Nabi, Ghulam
20d3e635-ec9c-4b53-8703-f50b443196da
Biyani, C Shekhar
2d96e24e-f3f3-4ba5-8258-73ba26f63321

Phillips, Rebecca, Hanchanale, Vishwanath S, Myatt, Andy, Somani, Bhaskar, Nabi, Ghulam and Biyani, C Shekhar (2015) Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database of Systematic Reviews, (10), CD010057. (doi:10.1002/14651858.CD010057.pub2).

Record type: Review

Abstract

Background: kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain.

Objectives: the objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones.

Search methods: we searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.

Selection criteria: we included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months.

Data collection and analysis: two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.

Main results: we included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89).

Author's conclusions: nitrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.

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More information

Published date: 6 October 2015
Keywords: Adult, Calcium Oxalate, Calcium Phosphates, Citrates, Drug Combinations, Humans, Kidney Calculi, Magnesium Compounds, Potassium Compounds, Randomized Controlled Trials as Topic, Recurrence, Secondary Prevention, Journal Article, Meta-Analysis, Review

Identifiers

Local EPrints ID: 419247
URI: http://eprints.soton.ac.uk/id/eprint/419247
ISSN: 1469-493X
PURE UUID: e23540c3-eb93-4e4d-891a-06a78200ef4e

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Date deposited: 09 Apr 2018 16:30
Last modified: 05 Oct 2018 11:54

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Contributors

Author: Rebecca Phillips
Author: Vishwanath S Hanchanale
Author: Andy Myatt
Author: Bhaskar Somani
Author: Ghulam Nabi
Author: C Shekhar Biyani

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