MP31-05 POTASSIUM CITRATE FOR URIC ACID STONE RISK: DOES DIABETES MATTER?

Abstract

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy II1 Apr 2018MP31-05 POTASSIUM CITRATE FOR URIC ACID STONE RISK: DOES DIABETES MATTER? Kimberly A Maciolek, Kristina L Penniston, and Sara L Best Kimberly A MaciolekKimberly A Maciolek More articles by this author , Kristina L PennistonKristina L Penniston More articles by this author , and Sara L BestSara L Best More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1034AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Potassium citrate (KCit) is recommended in the pharmacologic management of patients with hypocitraturia with or without acidic urine. It is indicated for the prevention of both calcium and uric acid stones. Diabetes mellitus (DM) is associated with acidic urine and increased risk for uric acid stones. While KCit is used in this patient population, its effectiveness has not been adequately assessed. We retrospectively evaluated 24-h urinary risk factors and changes in 24-h urine parameters associated with KCit therapy in cohorts of patients with and without DM. METHODS With IRB approval, we identified 161 stone formers (SFs) from clinical records, 32 of whom had DM. Patients were included if they underwent 24-h urine testing within 3 years before and after initiating KCit. Pre- and post-KCit urine parameters were compared between non-DM and DM SFs using univariate and multivariate analyses. Correcting for multiple statistical comparisons, a p-value of ≤0.003125 was required for significance. RESULTS Patients with DM were older (DM: 61 vs non-DM: 54, p=0.003) and had a higher BMI (34 vs 29, p<0.001). At baseline, SFs with DM had significantly lower urine pH (5.4 vs 6.1, p=0.002) and brushite RS (0.29 vs 1.2, p<0.0001). Similar baseline urine citrate (311 vs 251 mg/d, p=0.23) was observed. In both patients with and without DM, urinary potassium excretion increased (+24 mEq/d, p=0.0001; and +24 mEq/d, p<0.0001), suggesting KCit compliance. Patients in both groups achieved significant increases in urine citrate (DM, 311 to 606 mg/d, p<0.0001; non-DM, 251 to 449 mg/d, p<0.0001) and pH (DM, 5.4 to 6.4, p<0.0001; non-DM, 6.1 to 6.5, p<0.0001) and decreases in uric acid RS (DM, 2.3 to 0.51, p=0.0004; non-DM, 1.1 to 0.36, p<0.0001). SFs with DM but not those without DM exhibited a statistically significant increase in brushite RS (0.29 to 0.98, p=0.0003), likely due to higher urine pH, but nonetheless remained well below the risk cutoff of 2.0. CONCLUSIONS KCit therapy was associated with increased urine pH and citrate excretion in patients with DM, equivalent in patients without DM. While statistically equivalent, the increase in urinary citrate excretion was greater in patients with DM than in those without. Neither patients with nor without DM had clinically relevant increases in brushite RS while on KCit therapy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e412-e413 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kimberly A Maciolek More articles by this author Kristina L Penniston More articles by this author Sara L Best More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...