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Lemonade Therapy Increases Urinary Citrate and Urine Volumes in Patients with Recurrent Calcium Oxalate Stone Formation

  • Kristina L. Penniston
    Affiliations
    Department of Surgery, Division of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Thomas H. Steele
    Affiliations
    Department of Medicine, Nephrology Section, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Author Footnotes
    1 S. Y. Nakada is a consultant/advisor to Cook Urological, Incorporated.
    Stephen Y. Nakada
    Correspondence
    Reprint requests: Stephen Y. Nakada, M.D., Department of Surgery, Division of Urology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, G5/339 Clinical Science Center, Madison, WI 53792-3236.
    Footnotes
    1 S. Y. Nakada is a consultant/advisor to Cook Urological, Incorporated.
    Affiliations
    Department of Surgery, Division of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

    Department of Medicine, Nephrology Section, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
    Search for articles by this author
  • Author Footnotes
    1 S. Y. Nakada is a consultant/advisor to Cook Urological, Incorporated.

      Objectives

      Potassium citrate is prescribed to patients with calcium oxalate (CaOx) stone formation to increase urinary citrate and pH, thus reducing CaOx crystal formation. Lemonade therapy (LT) might also increase urinary citrate and the total urine volume. We compared the effects of LT alone (group 1, n = 63) and potassium citrate plus LT (group 2, n = 37) in patients with CaOx stone formation on the urinary citrate and total urine volume to determine the efficacy of LT.

      Methods

      Adult patients with CaOx stone formation and three or more clinic visits from 1996 to 2005 and three or more UroRisk profiles were included in our retrospective analysis.

      Results

      Urinary citrate increased maximally by 203 and 346 mg/day for groups 1 and 2, respectively. The maximal total urine volume increase was 763 and 860 mL/day for groups 1 and 2, respectively. The urinary citrate and total urine volume increased sooner during follow-up for group 1. By the last clinic visit, the urinary citrate and total urine volume had decreased in both groups. However, group 1 sustained a greater total urine volume than did group 2 (2.35 ± 0.10 standard error versus 2.17 ± 0.12 L/day). Urinary citrate was greater in group 1 (765 ± 56 standard error versus 548 ± 56 mg/day for group 2), but the change from baseline to the last visit was significant (P = 0.008) only in group 2.

      Conclusions

      LT resulted in favorable changes in urinary citrate and total urine volume in our series. Potassium citrate with LT was more effective than LT alone at increasing urinary citrate. Because maximal changes for urinary citrate and total urine volume were achieved earlier in follow-up, individualized encouragement and motivation should be provided to patients at each visit for sustained prevention.
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