<p><strong>In pediatric patients with calcium 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>Two studies have examined the use of alkali citrate for the prevention of stone recurrence in pediatric patients. In an RCT conducted in 96 children aged 4-14 years with calcium-containing kidney stones after SWL, investigators compared stone recurrence in children receiving daily alkali citrate provided in the form of potassium citrate at a dose of 1 mEq/kg/day versus children receiving no treatment.<sup>49</sup> Use of alkali citrate for 12 months was associated with reduced radiographic new stone formation in children who were stone-free at study entry (7.6% in potassium citrate group versus 34.6% in control group), and reduced stone growth or new stone formation in children who had residual stones at study entry (18.1% versus 72.7%).<sup>49</sup> In a non-randomized study, investigators retrospectively compared infants who were non-adherent versus adherent with an alkali therapy solution (100 g sodium citrate + 100 g potassium citrate + 1,000 mL distilled water at a dose of 1-2 mL/kg/day) daily.<sup>50</sup> Alkali treatment in infants with 3-5 mm kidney stones was associated with a greater likelihood of radiographic stone resolution at the end of 6 month follow-up (71% in adherent versus 52% in non-adherent infants), while stone resolution rate was similar in adherent and non-adherent infants with stones <3 mm in size.<sup>50</sup></p>