<p><strong>In adult patients with recurrent calcium oxalate kidney stones, clinicians may recommend alkali therapy to reduce the risk of stone recurrence. (<em>Conditional Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>Urinary citrate is an important inhibitor of calcium stone formation and growth, and multiple studies have examined the efficacy of alkali citrate therapy in reducing recurrent calcium stone formation. The pooled findings from four RCTs evaluating alkali citrate therapy versus placebo or no treatment in 330 individuals with a history of stones found a relative risk of composite symptomatic and radiographic stone recurrence of 0.24 (95% CI: 0.07 to 0.84) compared with either placebo or no treatment.<sup>32, 56, 60, 64</sup> Different formulations of alkali citrate were used, including potassium citrate,<sup>56, 64</sup> potassium magnesium citrate,<sup>32</sup> and sodium potassium citrate.<sup>60</sup> These studies enrolled participants with either pure or mixed calcium oxalate stones, and only a minority of participants exhibited low urinary citrate excretion at study entry. Although citrate is a potent inhibitor of calcium phosphate stone formation, no randomized study has examined the impact of alkali citrate on recurrent stone formation in patients with pure calcium phosphate stones. Please refer to <strong>Statement 38</strong> for guidance on monitoring for adverse effects of alkali therapy.</p>