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Effect of potassium citrate supplement on stone recurrence before or after lithotripsy: systematic review and meta-analysis

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Abstract

This meta-analysis summarizes the available evidence on the effectiveness of citrate supplement for preventing the recurrence of nephrolithiasis in patients undergoing extracorporeal shock wave lithotripsy (SWL). Electronic searches were conducted using Medline-PubMed, Web of Science, Embase, BVS (Scielo, Lilacs), and Google Scholar literature databases. The authors worked in pairs to select studies that met the following criteria: randomized controlled trials that were conducted in adults and assessed the effect of potassium citrate supplement before or after SWL therapy for urolithiasis. Our primary aim was to asses the stone-free rate among the groups included in the studies. Fixed effect was used in the meta-analysis with 95% confidence interval (95% CI). Heterogeneity was analyzed by the I 2 value. A total of 2505 references were initially selected. Of those, four were subjected to meta-analysis contributing five samples. These four studies included 374 participants who were followed for a period of 12 months after SWL. Mean potassium citrate dosage was approximately 55 mEq/day (18 mmol). The results showed that citrate supplement significantly protected against the recurrence of nephrolithiasis during 1 year after SWL [RR; 95% CI 0.21 (0.13, 0.31)]. The heterogeneity was not significant across the analyzed studies (p = 0.224). The quality of the analyzed studies was generally low. The available evidence shows that citrate supplement effectively reduces the recurrence of nephrolithiasis in patients undergoing SWL. However, statistical analysis of a larger trial conducted with methodological rigor is warranted.

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References

  1. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482. doi:10.1016/j.eururo.2015.07.041

    Article  PubMed  Google Scholar 

  2. Chongruksut W, Lojanapiwat B, Tawichasri C, Paichitvichean S, Euathrongchit J, Ayudhya VC, Patumanond J (2011) Kidney stones recurrence and regrowth after extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. J Med Assoc Thail (Chotmaihet thangphaet) 94(9):1077–1083

    Google Scholar 

  3. Trinchieri A, Ostini F, Nespoli R, Rovera F, Montanari E, Zanetti G (1999) A prospective study of recurrence rate and risk factors for recurrence after a first renal stone. J Urol 162(1):27–30. doi:10.1097/00005392-199907000-00007

    Article  CAS  PubMed  Google Scholar 

  4. Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR (1994) Management of lower pole nephrolithiasis: a critical analysis. J Urol 151(3):663–667

    Article  CAS  PubMed  Google Scholar 

  5. El-Nahas AR, El-Assmy AM, Madbouly K, Sheir KZ (2006) Predictors of clinical significance of residual fragments after extracorporeal shockwave lithotripsy for renal stones. Journal Endourol Endourol Soc 20(11):870–874. doi:10.1089/end.2006.20.870

    Article  Google Scholar 

  6. Pettersson B (1989) Extracorporeal shock wave lithotripsy of renal and ureteral stones–studies on indications, methods and results. Scand J Urol Nephrol Suppl 120:1–80

    CAS  PubMed  Google Scholar 

  7. Cicerello E, Merlo F, Maccatrozzo L (2008) Management of residual fragments after SWL. Archivio Italiano di Urologia e Andrologia 80(1):34–38

    PubMed  Google Scholar 

  8. Lojanapiwat B, Tanthanuch M, Pripathanont C, Ratchanon S, Srinualnad S, Taweemonkongsap T, Kanyok S, Lammongkolkul S (2011) Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy. Int Braz J Urol 37(5):611–616

    Article  CAS  PubMed  Google Scholar 

  9. Zuckerman JM, Assimos DG (2009) Hypocitraturia: pathophysiology and medical management. Rev Urol 11(3):134–144

    PubMed  PubMed Central  Google Scholar 

  10. Pak CY (1994) Citrate and renal calculi: an update. Miner Electrolyte Metab 20(6):371–377

    CAS  PubMed  Google Scholar 

  11. Pak CY (2004) Medical management of urinary stone disease. Nephron Clin Pract 98(2):c49–c53. doi:10.1159/000080252

    Article  PubMed  Google Scholar 

  12. Pak CY, Fuller C, Sakhaee K, Preminger GM, Britton F (1985) Long-term treatment of calcium nephrolithiasis with potassium citrate. J Urol 134(1):11–19

    Article  CAS  PubMed  Google Scholar 

  13. Ziemba JB, Matlaga BR (2015) Guideline of guidelines: kidney stones. BJU Int 116(2):184–189. doi:10.1111/bju.13080

    Article  PubMed  Google Scholar 

  14. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TM, White JR (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316–324. doi:10.1016/j.juro.2014.05.006

    Article  PubMed  Google Scholar 

  15. Soygur T, Akbay A, Kupeli S (2002) Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial. J Endourol Endourol Soc 16(3):149–152. doi:10.1089/089277902753716098

    Article  Google Scholar 

  16. Goktas C, Horuz R, Akca O, Cetinel CA, Canguven O, Kafkasli A, Albayrak S, Sarica K (2012) The effect of citrate replacement in hypocitraturic cases on the results of SWL: a preliminary prospective randomized study. Int Urol Nephrol 44(5):1357–1362. doi:10.1007/s11255-012-0190-4

    Article  PubMed  Google Scholar 

  17. Verdejo AJ, Martin MA, Ortiz JLM, Rosino EH, Yago FP, Gomez AZ (2001) Effect of potassium citrate in the prevention of urinary lithiasis. Arch Esp Urol 54(9):1036–1046

    Google Scholar 

  18. Cicerello E, Merlo F, Gambaro G, Maccatrozzo L, Fandella A, Baggio B, Anselmo G (1994) Effect of alkaline citrate therapy on clearance of residual renal stone fragments after extracorporeal shock wave lithotripsy in sterile calcium and infection nephrolithiasis patients. J Urol 151(1):5–9

    Article  CAS  PubMed  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. doi:10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  20. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi:10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  21. Follmann D, Elliott P, Suh I, Cutler J (1992) Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 45(7):769–773

    Article  CAS  PubMed  Google Scholar 

  22. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Resorlu B, Sancak EB, Akbas A, Gulpinar MT (2014) Time to say good bye to shockwave lithotripsy? World J Urol 32(1):297–298. doi:10.1007/s00345-013-1109-0

    Article  PubMed  Google Scholar 

  24. Rassweiler JJ, Renner C, Chaussy C, Thuroff S (2001) Treatment of renal stones by extracorporeal shockwave lithotripsy: an update. Eur Urol 39(2):187–199. doi:10.1159/000052435

    Article  CAS  PubMed  Google Scholar 

  25. Oguz U, Unsal A (2013) The efficacy of medical prophylaxis in children with calcium oxalate urolithiasis after percutaneous nephrolithotomy. J Endourol Endourol Soc 27(1):92–95. doi:10.1089/end.2012.0243

    Article  Google Scholar 

  26. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012. doi:10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Escola de Medicina, PUCPR-Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155-Prado Velho, Curitiba, Paraná, Brazil

    Maurício Carvalho, Eduardo Yukio Kuwaki, Halyson Pinheiro Pontes, Jonathan Wei Ting Wen Liu, Luis Henrique Boros, Marcelo Oliveira Asinelli & Cristina Pellegrino Baena

  2. Hospital de Clínicas, UFPR-Universidade Federal do Paraná, Rua General Carneiro, 181-Alto da Glória, Curitiba, Paraná, Brazil

    Maurício Carvalho & Bruna Olandoski Erbano

  3. Hospital Marcelino Champagnat, Av. Pres. Affonso Camargo, 1399-Cristo Rei, Curitiba, Paraná, Brazil

    Cristina Pellegrino Baena

Authors
  1. Maurício Carvalho
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  2. Bruna Olandoski Erbano
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  3. Eduardo Yukio Kuwaki
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  4. Halyson Pinheiro Pontes
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  5. Jonathan Wei Ting Wen Liu
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  6. Luis Henrique Boros
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  7. Marcelo Oliveira Asinelli
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  8. Cristina Pellegrino Baena
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Correspondence to Bruna Olandoski Erbano.

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The authors declare that they have no conflict of interest.

Ethical statement

This manuscript was not submitted to another journal for simultaneous consideration and has not been published previously (partly or full). No data have been fabricated or manipulated. No data, text or theories by others are presented. Consent to submit has been received explicitly from all co-authors, as well as from the responsible authorities at the institutions where the work has been carried out. The authors whose names appear on the submission have contributed sufficiently to scientific work and, therefore, share collective responsibility and accountability for the results. Since this is a systematic review and meta-analysis article, this article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

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Fig. 4
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Funnel plot with pseudo 90% confidence limits

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Carvalho, M., Erbano, B.O., Kuwaki, E. et al. Effect of potassium citrate supplement on stone recurrence before or after lithotripsy: systematic review and meta-analysis. Urolithiasis 45, 449–455 (2017). https://doi.org/10.1007/s00240-016-0950-1

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  • DOI: https://doi.org/10.1007/s00240-016-0950-1

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