What question did this study set out to answer?

The study aimed to evaluate the long-term metabolic effects of citrate therapy in high-risk kidney stone formers.

May 21, 2026Open Access

Long-term citrate treatment in high-risk kidney stone formers is not associated with metabolic adverse effects.

Key Points

The study aimed to evaluate the long-term metabolic effects of citrate therapy in high-risk kidney stone formers.
Participants included 654 kidney stone formers (110 with citrate treatment) and 207 controls.
Blood and urine analyses were conducted at baseline and over 2 years, with follow-ups on stone events.
Propensity score matching was employed to compare metabolic and urinary outcomes between treated and untreated groups.
No significant differences in metabolic outcomes were observed between citrate and non-citrate patients over 1-2 years.
43% of citrate patients had stone recurrence compared to 30% of non-citrate patients, with no shift to calcium phosphate stones in citrate users.
Citrate treatment selectively reduced uric acid supersaturation, while non-treated patients had greater reductions in brushite supersaturation.

Abstract

Background Citrate is frequently applied in kidney stone formers (KSFs), yet long-term safety data are lacking. We evaluated the effects of prolonged citrate therapy on metabolic health, urinary risk factors and stone recurrence in high-risk KSFs in Switzerland.Methods The Swiss Kidney Stone Cohort (SKSC) is a multicenter study including KSFs and controls. Blood and urine analyses were performed at baseline and longitudinally over 2 years in KSFs, with subsequent telephone follow-up for stone events. A total of 654 KSFs (110 with citrate, 544 without) and 207 controls were included. Outcomes comprised anthropometric indices (body mass index, body roundness index, waist-to-hip ratio), metabolic parameters, urinary relative supersaturation ratios (RSR), stone recurrence and stone composition.Results No evidence for between-group differences in 1- to 2-year changes in anthropometric, glucose or lipid outcomes was identified. Anthropometric indices remained stable in both groups. HbA1c rose in non-citrate (NC) but not in citrate (C) group patients. High-density lipoprotein (HDL) cholesterol increased in both groups, while low-density lipoprotein (LDL) decreased only in C patients. Propensity score-matched analyses showed no between-group differences in 1- to 2-year changes in anthropometric, glucose or lipid outcomes, with only modest within-group changes in the C group (hemoglobin A1c, HDL- and LDL-cholesterol). Urine analyses showed a greater reduction in RSR for brushite among NC patients, whereas C patients had a stronger decline in uric acid (UA) RSR. Calcium oxalate RSR decreased similarly across groups. Stone recurrence was more frequent in C patients, with 43% versus 30% of NC patients changing stone type during follow-up. No shift toward calcium phosphate stones was observed in citrate users.Conclusions Long-term citrate therapy appeared metabolically safe, and selectively reduced UA supersaturation, while non-treated patients showed a more pronounced decrease for brushite. Higher recurrence among treated patients may reflect different baseline risk. A prospective trial is warranted to clarify additive benefits of citrate beyond dietary-guided counseling.

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Cite This Study

Ritter et al. (Fri,) studied this question.

synapsesocial.com/papers/6a0ea10ebe05d6e3efb5f69b https://doi.org/https://doi.org/10.48620/97814

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