Objective and background The purpose of this review is to systematically synthesize clinical studies evaluating changes in 24-hour urine parameters in patients receiving potassium citrate.Materials and methods A systematic review and multilevel analysis were conducted according to PRISMA and a registered protocol (PROSPERO CRD420261282247). Literature searches without date restriction identified studies reporting daily urine change among patients with urolithiasis taking potassium citrate therapy. The main object of analysis was the change (Δ) in each parameter between the baseline level and the state during potassium citrate therapy.Results Eight studies containing nine groups were included. The average increase in diuresis was 0.21 L/day. ΔpH and Δcitrate against the background of potassium citrate therapy across studies was +0.64 and +1.04, respectively. No consistent associations were observed for changes in uric acid (UA), sodium, calcium, magnesium, ammonium, phosphate, or sulfate, although the small number of studies and substantial between-study heterogeneity limit inference. Potassium citrate therapy was also associated with a decrease in urinary oxalate (Δoxalate −0.173 mmol/day), which should be interpreted cautiously given the limited evidence base.Conclusion Potassium citrate therapy was associated with study-level changes in the 24-hour urine profile that appeared to vary by dose and baseline metabolic phenotype. Increases in urinary pH and citrate were not observed uniformly across studies, but were broadly consistent with the delivered alkaline load within a pharmacodynamic framework. Reductions in calciuria and uricosuria appeared more evident in cohorts with underlying metabolic abnormalities, although these patterns remain hypothesis-generating. Overall, these findings support consideration of a more individualized, monitoring-based approach to potassium citrate titration rather than uniform empirical administration.
Talyshinskii et al. (Sun,) studied this question.