Kidney Stone Recurrence Research Articles

This Month in Pediatric Urology

No AccessJournal of UrologyThis Month in Pediatric Urology1 Jan 2017This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.10.031AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Pediatric Urology." The Journal of Urology, 197(1), p. 4 References 1 : Kidney stone recurrence among children and adolescents. J Urol2017; 197: 246. Link, Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 197Issue 1January 2017Page: 4 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julian Wan More articles by this author Expand All Advertisement PDF downloadLoading ...

Kidney Stone Recurrence among Children and Adolescents

Kidney stone disease has become increasingly common during childhood and adolescence. However, the rate of symptomatic kidney stone recurrence for pediatric patients is uncertain. We sought to determine the recurrence rate of symptomatic kidney stones in a cohort of children with incident symptomatic nephrolithiasis. We performed a retrospective cohort study of patients 3 to 18 years old without anatomical abnormalities or genetic causes of nephrolithiasis who presented with a first symptomatic kidney stone between 2008 and 2014. We determined recurrence rates of symptomatic nephrolithiasis, defined as a new kidney stone on ultrasound and/or computerized tomogram associated with pain and/or vomiting. We also estimated associations between completing 24-hour urinalysis and symptomatic kidney stone recurrence using Kaplan-Meier curves and multivariable Cox regression models. A total of 285 children with a median age of 14.8 years (IQR 11.3-16.6) at nephrolithiasis diagnosis were followed for 492 person-years. A total of 86 symptomatic recurrent stones developed in 68 patients (24%) during the followup period. The probability of symptomatic stone recurrence was 50% at 3 years after the index kidney stone. Median time to stone recurrence was 3 years at the first recurrence and 5 years at the second. Adjusting for confounders including adherence to followup, completing a 24-hour urinalysis after a kidney stone episode was associated with a 60% decreased risk of recurrence (hazard ratio 0.40, 95% CI 0.18-0.91). The risk of kidney stone recurrence is high during childhood, with approximately 50% of children presenting with symptomatic recurrence within 3 years of the first stone. The role and usefulness of analyzing 24-hour urine chemistries in decreasing kidney stone recurrence should be explored in future prospective studies.

Factors associated with patient recall of individualized dietary recommendations for kidney stone prevention.

Dietary approaches to preventing the recurrence of idiopathic calcium-containing kidney stones are effective. However, a lifelong commitment to prevention is challenging for many patients. Multiple patient factors likely account for compliance and adherence with dietary recommendations. We examined patients' recall and compliance with dietary recommendations provided during clinical evaluation. Of 275 patients who received dietary recommendations from a dietitian, 112 completed an investigator-designed survey querying their recollection of dietary recommendations. Patients' responses were compared with the recommendations actually provided as entered in patients' medical records. Patients (62% male, 56±13 years; 38% female, 52±14 years) were provided 3.4±1.1 recommendations (min-max, 1-6) and recalled 67% of recommendations. Highest recalls were for (i) lower meat/fish/poultry intake, (ii) higher fluid intake and (iii) lower sodium (⩾68% for all). Lowest recalls were for weight loss, using citrus juices and increasing fruits/vegetables (⩽61% for all). Forty-seven percent of patients given 1-3 recommendations recalled 100%, whereas only 23% of patients provided >3 recommendations did so (P=0.011). Even though 38% of patients reported some difficulty following dietary recommendations, nearly all (91%) said that they were willing to continue following them. Higher patient recall is associated with ⩽3 dietary recommendations. Patient recall of recommendations that were not actually provided ('false recall') may contribute to reduced recall and confusion about the most important dietary strategies to reduce their stone risk. Accordingly, providers should prioritize the most important dietary recommendations, reserving those less important for follow-up, and address any confusion patients have from information received prior to evaluation.

Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature.

Nephrolithiasis is a frequent condition. While it is generally accepted that such condition carries a risk of recurrence over time, the exact risk and its predictors have been rarely quantitated. We aimed to estimate recurrence of kidney stones, overall and in specific subgroups, from randomized controlled trials (RCTs) of calcium stone formers. Systematic review of RCTs of adult patients with idiopathic calcium kidney stones. Recurrence rates analyzed in subgroups based on type of intervention and other characteristics, using Poisson regression models. The analysis included 21 RCTs with 2168 participants over a median follow-up of 3.2years (range 0.5-9.7). The median recurrence of kidney stones was 15 per 100 person-years (range 0-110). Recurrence was higher in those with two or more previous stone episodes compared to those with a single episode at enrolment (16 vs. 6 per 100 person-years, p<0.001) and in those untreated or treated with dietary changes compared to those treated with drugs (26 vs. 23 vs. 9 per 100 person-years, p<0.001). The effect of drugs on recurrence seemed to be beneficial only among those with two or more previous stone episodes. The overall recurrence rate of stones depends on factors such as previous stone history and type of treatment. Dietary approaches seem to be more effective among single stone formers, whereas drugs seem to be more effective among recurrent stone formers.

Therapy of nephrolithiasis: where is the evidence from clinical trials?

The prevalence of kidney stone disease is increasing worldwide with significant health and economic burden. Newer research is finding that stones are associated with several serious morbidities. Yet, few randomized clinical trials or high quality observational studies have assessed whether clinical interventions decrease the recurrence of kidney stones. Therefore, in this review we analyze the available evidence on medical expulsive therapy for ureteral stones; describe the evidence about non-pharmacological stone therapy including dietary modifications and citrus juice-based therapy; and discuss the efficacy of thiazide diuretics for the treatment of hypercalciuria in recurrent nephrolithiasis.

Evaluation of citraturia and calcium/citrate ratio in nephrolithiasis patients. The continuous versus interval saga

Introduction: Despite the progress in the pathogenesis of nephrolithiasis, the individual risk assessment of formation and recurrence of kidney stones by measuring risk factors in 24-hour urine is often difficult. Our objective was to evaluate urinary risk factors associated with nephrolithiasis, particularly citraturia and the calcium/citrate ratio in recurrent kidney stones formers and in subjects without nephrolithiasis. Methods: 103 kidney stone formers (30 men and 73 women) and 32 non-stone subjects (11 men and 21 women) were retrospective studied. Clinical and laboratory data were collected from every subject. Results: There was no difference in age between the groups (44.4±11.8 years and 43.3±17 years). In urine, volume, calcium (189.6±98.7 vs. 150.7±107.3, p=0.029), sodium and oxalate (33.7±28.2 vs. 22.2±15.3, p=0.041) were higher in kidney stones when compared to control subjects. Urinary excretion of uric acid and citrate was similar in both groups, with no significant differences. For the cohort of stone formers patients, but not for healthy subjects, there was a positive correlation between calcium and citrate excretion in urine (r=0.41, p<0.001). When utilizing the calcium/citrate ratio to differentiate stone and non-stone formers subjects, we could not find any difference. Conclusion: For the kidney stone formers, the assessment of risk factors by 24-hour urine needs to be categorized as continuous and not as interval variables. Prospective studies are necessary to determine the normal range of daily citraturia and to evaluate the role of isolated hypocitraturia in the incidence, prevalence and clinical course of kidney stone formation

Current Trends, Evaluation, and Management of Pediatric Nephrolithiasis.

The incidence of pediatric nephrolithiasis has been steadily increasing for the past several decades, with a concomitant concerning increase in health care costs and burden to children with this disease. Recent population-based studies have also demonstrated a change in the current trends of pediatric nephrolithiasis that is characterized by a significant increase in the number of girls now being affected. While changes in diet and lifestyle, obesity prevalence, and even imaging practices have been proposed to contribute to the recent increase in pediatric nephrolithiasis, a definite underlying cause remains elusive. This situation is complicated by the fact that, unlike in adults, the trends occurring in pediatric nephrolithiasis have not been studied rigorously, which contributes to the paucity of data in children. The level of concern with the increasing incidence is raised by factors unique to pediatric nephrolithiasis that could expose an affected child to more complications. Factors such as variable clinical presentation, high recurrence of kidney stones associated with abnormalities of metabolism and the urinary tract, and the possible presence of rare genetic kidney stone diseases would require physicians to comprehensively evaluate patients presenting with kidney stones. The goal of evaluation is to identify modifiable risk factors and abnormalities for which targeted therapy can be prescribed. The goals of medical and surgical treatments are to eliminate the burden of kidney stones and prevent recurrence while simultaneously minimizing complications from interventions. Patients at high risk may benefit from a specialized kidney stone clinic staffed by a pediatric nephrologist, urologist, dietitian, and clinical nurse. Such a multidisciplinary clinic can help provide the medical and surgical support needed for patients at high risk and offer key opportunities to learn more about pediatric nephrolithiasis, thereby fueling the much-needed research in this field.

Effect of minimally invasive percutaneous nephrolithotomy in treatment of recurrence of kidney stones after open operation

Objective To explore the curative effect of minimally invasive percutaneous nephrolithotomy in treatment of recurrence of kidney stones after open operation. Methods 56 patients with postoperative recurrence of renalcalculi were retrospectively reviewed. They were randomly divided into the control group and the observation group. The observation group was treated by minimally invasive percutaneous nephrolithotomy, while the control group received the open operation. The stone clearance rate, operation time and hospitalization time of the two groups were compared. Results The stone clearance rate in the observation group was 92.86%,which was significantly higher than 64.29% of the control group(χ2= 11.37,P<0.05); The average operation time in the control group was(131.8±8.9)min, which was more than(92.5±5.4)min of the observation group; The average hospital stay in the control group was(19.7±3.2)days, which was more than(10.4± 2.6)days of the observation group, the differences were statistically significant(t= 16.38,17.25,all P< 0.05). Conclusion Minimally invasive percutaneous nephrolithotomy can improve the stone clearance rate in treatment of recurrent renal calculi after open operation, which can shorten the operation time and hospital stay, it is worth the clinical promotion Key words: Nephrolithotomy, Percutaneous; Operation; Kidney stones

A Single Nucleotide Polymorphism (rs4236480) in TRPV5 Calcium Channel Gene Is Associated with Stone Multiplicity in Calcium Nephrolithiasis Patients.

Nephrolithiasis is characterized by calcification of stones in the kidneys from an unknown cause. Animal models demonstrated the functional roles of the transient receptor potential vanilloid member 5 (TRPV5) gene in calcium renal reabsorption and hypercalciuria. Therefore, TRPV5 was suggested to be involved in calcium homeostasis. However, whether genetic polymorphisms of TRPV5 are associated with kidney stone multiplicity or recurrence is unclear. In this study, 365 Taiwanese kidney-stone patients were recruited. Both biochemical data and DNA samples were collected. Genotyping was performed by a TaqMan allelic discrimination assay. We found that a TRPV5 polymorphism (rs4236480) was observed to be associated with stone multiplicity of calcium nephrolithiasis, as the risk of stone multiplicity was higher in patients with the TT+CT genotype than in patients with the CC genotype (p = 0.0271). In summary, despite the complexity of nephrolithiasis and the potential association of numerous calcium homeostatic absorption/reabsorption factors, TRPV5 plays an important role in the pathogenesis of calcium nephrolithiasis.

Nutritional Management of Kidney Stones (Nephrolithiasis).

The incidence of kidney stones is common in the United States and treatments for them are very costly. This review article provides information about epidemiology, mechanism, diagnosis, and pathophysiology of kidney stone formation, and methods for the evaluation of stone risks for new and follow-up patients. Adequate evaluation and management can prevent recurrence of stones. Kidney stone prevention should be individualized in both its medical and dietary management, keeping in mind the specific risks involved for each type of stones. Recognition of these risk factors and development of long-term management strategies for dealing with them are the most effective ways to prevent recurrence of kidney stones.

Knowledge, attitudes, and practice patterns among healthcare providers in the prevention of recurrent kidney stones in Northern Ontario.

Kidney stone recurrence is common. Preventive measures can lead to improved quality of life and costs savings to the individual and healthcare system. Guidelines to prevent recurrent kidney stones are published by various urological societies. Adherence to guidelines amongst healthcare professionals in general is poor, while adherence to preventive management guidelines regarding stone disease is unknown. To understand this issue, we conducted an online study to assess the knowledge, attitudes, and practice patterns of healthcare practitioners in Northern Ontario. We used the database of healthcare providers affiliated with the Northern Ontario School of Medicine, in Sudbury (East Campus) and Thunder Bay (West Campus), Ontario. We designed the survey based on current best practice guidelines for the management of recurrent kidney stones. Questions covered 3 domains: knowledge, attitudes, and practice patterns. Demographic data were also collected. The survey was distributed electronically to all participants. A total of 68 healthcare providers completed the survey. Of these, most were primary care physicians (72%). To keep uniformity, we analyzed the data of this homogenous group. A total of 70% of the respondents were aware of the current guidelines; however, only 43% applied their knowledge in clinical practice. Most participants lacked confidence while answering most items in the attitude domain. Most primary care physician respondents were aware of the appropriate preventive measures for recurrent kidney stones; however, they do not appear to apply this knowledge effectively in clinical practice. A low response rate is a limitation of our study. Further studies involving a larger sample size may lead to information sharing and collaborative care among healthcare providers.

Commentary on Silent Renal Stones in Primary Hyperparathyroidism: Prevalence and Clinical Features

Commentary on Silent Renal Stones in Primary Hyperparathyroidism: Prevalence and Clinical Features

Dietary Intake of Fiber, Fruit and Vegetables Decreases the Risk of Incident Kidney Stones in Women: A Women’s Health Initiative Report

We evaluated the relationship between dietary fiber, fruit and vegetable intake, and the risk of kidney stone formation. Overall 83,922 postmenopausal women from the Women's Health Initiative observational study were included in the analysis and followed prospectively. Cox proportional hazards regression analyses were used to evaluate the associations between total dietary fiber, fruit and vegetable intake, and the risk of incident kidney stone formation, adjusting for nephrolithiasis risk factors (age, race/ethnicity, geographic region, diabetes mellitus, calcium supplementation, hormone therapy use, body mass index and calibrated caloric intake; and dietary water, sodium, animal protein and calcium intake). Women with a history of kidney stones (3,471) were analyzed separately. Mean age of the women was 64±7 years, 85% were white and 2,937 (3.5%) experienced a kidney stone in a median followup of 8 years. In women with no history of kidney stones higher total dietary fiber (6% to 26% decreased risk, p <0.001), greater fruit intake (12% to 25% decreased risk, p <0.001) and greater vegetable intake (9% to 22% decreased risk, p=0.002) were associated with a decreased risk of incident kidney stone formation in separate adjusted models. In women with a history of stones there were no significant protective effects of fiber, fruit or vegetable intake on the risk of kidney stone recurrence. Greater dietary intake of fiber, fruits and vegetables was associated with a reduced risk of incident kidney stones in postmenopausal women. The protective effects were independent of other known risk factors for kidney stones. In contrast, there was no reduction in risk in women with a history of stones.

2096 KIDNEY STONE CLINIC QUALITY: EFFECT ON HYPEROXALURIA

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management (I)1 Apr 20132096 KIDNEY STONE CLINIC QUALITY: EFFECT ON HYPEROXALURIA Zeyad Schwen, Julie Riley, Yaniv Shilo, and Timothy Averch Zeyad SchwenZeyad Schwen Pittsburgh, PA More articles by this author , Julie RileyJulie Riley Pittsburgh, PA More articles by this author , Yaniv ShiloYaniv Shilo Pittsburgh, PA More articles by this author , and Timothy AverchTimothy Averch Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2005AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Kidney stone clinics evaluate and manage metabolic risk factors such as hyperoxaluria with the purpose of preventing kidney stone recurrence. While dietary modification has been shown to reduce urine oxalate in controlled studies, a question remains of whether results can be reproduced in actual clinical practice, taking into account patient noncompliance and quality of care. This study also ascertains whether certain patient characteristics independently affect a patient's ability to decrease urine oxalate. METHODS Retrospectively, 267 kidney stone patients from 2005 to 2011 with urine oxalate values greater than 40 mg/d on 24-hour urine sampling were evaluated. Chart reviews for each patient included recording patient characteristics, dietary modification counseling, noncompliance, failure to keep appointments, and the change in urine oxalate values. Enteric and primary hyperoxalurics were excluded. RESULTS Overall, hyperoxaluric patients had a significant decrease in urine oxalate of 8.94 mg/d (5.8 to 12.0). 48.1% of patients were able to decrease their urine oxalate to below 40mg/d, the upper threshold of normal. From the patient characteristics we found females were able to significantly reduce urine oxalate compared to males (12.6 mg/d vs 6.55 mg/d, p=0.012), BMI negatively correlated with delta oxalate (Pearson's r = -0.213, p=0.01), and having a previous kidney stone appeared to limit a patient's delta oxalate (7.61 mg/d vs 15.1 mg/d, p=0.052). Of the 267 patients only 59% completed a second 24 hour urine sample, 27.4% of patients did not keep a follow-up appointment at some point during their treatment, and 10% were noted as being noncompliant. There was no clear effect of these compliance measures on delta oxalate. Change in urine volume, however, did negatively correlate significantly with delta oxalate (Pearson's r = -0.210, p=0.01). CONCLUSIONS Overall, patients who were seen in the outpatient kidney stone clinic who were treated with dietary management had a significant reduction in urine oxalate and almost half were able to reduce their oxalate to below the upper threshold of normal. Females and patients with a lower BMI are able to reduce urine oxalate better. There appears to be a trend towards reduced urine oxalate reduction if a patient has a previous stone history. Patient compliance and follow-up remains a significant challenge, however the only compliance measure that correlated with a greater oxalate reduction was increasing urine volume. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e860 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zeyad Schwen Pittsburgh, PA More articles by this author Julie Riley Pittsburgh, PA More articles by this author Yaniv Shilo Pittsburgh, PA More articles by this author Timothy Averch Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Nanocrystallites in urine and their relationship with the formation of kidney stones

AbstractKidney stones are mainly composed of inorganic crystals such as calcium oxalate (CaOxa). At present, kidney stones can be detected only after their formation, which causes great suffering for patients. If kidney stones can be detected prior to their formation, they can be effectively prevented, which presents great commercial value. In this paper, we review the differences in urine nanocrystallites between stone-forming patients and healthy controls, as well as the relationship between nanocrystallites in urine and the formation of kidney stones. These differences are microcrystalline morphology, aggregation, size and distribution, chemical composition, Zeta potential and stability. The results showed that the formation of kidney stones is closely related to the nature of nanocrystallites. Through the regulation of the physical and chemical properties of nanocrystallites, the formation and recurrence of kidney stones are possibly inhibited.

The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL)

Study Type--Prognosis (cohort) Level of Evidence 2b. What's known on the subject? and What does the study add? The presence of metabolic syndrome is associated with development of kidney stones and an increase in the stone-recurrence rate. However, studies reporting long-term results of percutaneous nephrolithotomy (PCNL) in metabolic syndrome are lacking. The present study showed that metabolic syndrome was associated with worsening renal function at long-term follow-up and the stone-recurrence rate recurrence after PCNL in patients with metabolic syndrome was 3.2-fold higher compared with the control group. • To investigate the impact of metabolic syndrome on long-term kidney function and stone recurrence rates after percutaneous nephrolithotomy (PCNL). • In all, 73 patients with metabolic syndrome who underwent stone analysis and had a minimum follow-up of 12 months after PCNL were reviewed. • In addition, 73 patients without any metabolic syndrome components who had undergone PCNL and were followed-up for at least 12 months were included in the study as the control group. • These control group patients were selected from 226 patients who were matched with the patients with metabolic syndrome using a 1 : 1 ratio. The matching parameters were age, gender and stone size. • Stone analyses showed that calcium oxalate monohydrate (52.0%) and uric acid (21.9%) were most common among patients with metabolic syndrome, whereas calcium oxalate monohydrate (76.7%) was the most common stone type in the control group. • Stone recurrences occurred with a mean (sd, range) of 36.1 (21.3, 12-109) months follow-up in 26 patients (41.9%) and 12 patients (18.9%) in the metabolic syndrome and control groups, respectively (P = 0.003). • While estimated glomerular filtration rate was decreased from 87.8 to 66.6 mL/min/1.73 m(2) in the metabolic syndrome group, it changed from 96.4 to 91.2 mL/min/1.73 m(2) in control group at long-term follow-up. • The most frequent stone type was calcium oxalate monohydrate in patients with or without metabolic syndrome. • In patients with metabolic syndrome who underwent PCNL, the stone recurrence rate was >40%. • Metabolic syndrome is associated with worsening renal function at long-term follow-up.

PUK4 the Effect of Prevention Using Drug Therapy on Kidney Stone Recurrence After Minimally Invasive Surgery in Kaiser Permanente Southern California (Kpsc)

PUK4 the Effect of Prevention Using Drug Therapy on Kidney Stone Recurrence After Minimally Invasive Surgery in Kaiser Permanente Southern California (Kpsc)

Factors Affecting Kidney Function and Stone Recurrence Rate After Percutaneous Nephrolithotomy for Staghorn Calculi: Outcomes of a Long-Term Followup

There are few studies of the long-term outcome of percutaneous nephrolithotomy for staghorn calculi. We report the long-term outcome of percutaneous nephrolithotomy in patients with staghorn calculi. A total of 265 study patients (272 renal units) were followed in the long term for greater than 12 months. The estimated glomerular filtration rate was calculated using the 4-variable modification of diet in renal disease equation. Cases were staged for chronic kidney disease by National Kidney Foundation guidelines. The impact of patient and procedure related factors on renal function as well as stone recurrence was analyzed retrospectively. At a mean ± SD followup of 37.3 ± 25.4 months the chronic kidney disease stage classification was maintained in 177 patients (66.8%) while the classification of 34 (12.8%) and 54 (20.4%) had improved and deteriorated, respectively. Multivariate analysis revealed that an immediate postoperative change in the estimated glomerular filtration rate was the only factor predicting a change in renal function in the long term. Stones recurred in 73 of the 234 kidneys (31.2%) that were stone free 3 months after percutaneous nephrolithotomy. Stone size increased in 24 of the 38 kidneys (63.2%) with residual stones after intervention. Recurrent urinary infections during followup and diabetes were associated with stone recurrence and residual stone enlargement. In almost 80% of patients with staghorn stones renal function was improved or maintained after percutaneous nephrolithotomy, as documented during long-term followup. Stones recurred in a third of the patients with staghorn calculi.

The mechanism of hypocalciuria with NaCl cotransporter inhibition

Thiazide diuretics are used to prevent the recurrence of calcium-containing kidney stones. The ability of these drugs to reduce urinary calcium excretion has a key role in this process. Although studies have shown a reduction in the recurrence rate of calcium-containing stones in patients treated with thiazides, whether hypocalciuria results from increased calcium reabsorption in the proximal or distal nephron is still unclear. When extracellular fluid volume is considerably reduced, the proximal tubule is likely to have a major role in thiazide-induced hypocalciuria. This process frequently occurs when high doses of thiazides and sodium restriction are prescribed for the treatment of kidney stone disease. The distal tubule is predominantly involved in NaCl cotransporter inhibition-induced hypocalciuria when the extracellular fluid volume is not reduced, a clinical scenario observed in patients with Gitelman syndrome. In this Perspectives article, we discuss the evidence supporting the hypocalciuric effects of NaCl cotransporter inhibition in the proximal and distal nephron.

Splenda® Improves Tolerance of Oral Potassium Citrate Supplementation for Prevention of Stone Formation: Results of a Randomized Double-Blind Trial

Oral citrate supplements have been shown to decrease kidney stone recurrence rates in both laboratory and clinical studies. The taste of the citrate supplements, however, is poor, and long-term compliance is low. Our objective was to determine if Splenda(®) added to potassium citrate (KCit) improves palatability without changing 24-hour urine parameters. 12 subjects were randomly assigned to receive either KCit alone for 3 days or KCit + Splenda in a double-blind trial. The 24-hour urine collections were performed before and after 3 days of therapy. After 1 week, the two groups switched treatments. After each treatment, a visual analog taste scale was completed to gauge the taste and palatability. The 24-hour urine parameters of kidney stone risk factors were compared between groups. The primary end points were to determine whether Splenda improved palatability of citrate supplementation and whether it altered 24-hour urine parameters. Taste was judged to be 2.5 ± 0.9 points better in the Splenda + KCit compared with KCit alone (P=0.02). The 24-hour Cit, K, and pH were significantly higher in the KCit and KCit + Splenda groups compared with baseline, but not significantly different from each other. Splenda significantly improves the palatability of KCit therapy and does not alter the beneficial effects of KCit on 24-hour urine Cit, K, or pH. The addition of Splenda altered the average taste score from one that might prohibit compliance to one that would not.