University of Montreal
Over-the-counter alkali agents to raise urine pH and citrate excretion: A randomized crossover study in healthy adults
Naeem Bhojani1, Noah E Canvasser2, Marcelino Rivera3, Seth K Bechis4, Johann Ingimarsson5, John Knoedler6, Karen Stern7, Christa Stoughton3, Daniel Wollin8, Michael Borofsky9, Marawan El Tayeb10, Guido Kamphuis11, David Leavitt12, Ryan S Hsi13, Kymora B Scotland14.
1Urology, University of Montreal, Montreal, QC, Canada; 2Urology, University of California Davis, Sacramento, CA, United States; 3Urology, Indiana University, Indianapolis, IN, United States; 4Urology, University of California San Diego, San Diego, CA, United States; 5Urology, Maine Medical Center, South Portland, ME, United States; 6Urology, Penn State University, Hershey, PA, United States; 7Urology, Mayo Clinic, Phoenix, AZ, United States; 8Urology, Brigham and Women's Hospital, Boston, MA, United States; 9Urology, University of Minnesota, Minneapolis, MN, United States; 10Urology, Baylor Scott and White Health, Temple, TX, United States; 11Urology, Amsterdam University Medical Center, Amsterdam, Netherlands; 12Urology, Henry Ford Health System, Detroit, MI, United States; 13Urology, Vanderbilt University Medical Center, Nashville, TN, United States; 14Urology, University of California Los Angeles, Los Angeles, CA, United States
Collaborative for Research in Endourology (CoRE).
Introduction: To prospectively study the effect of over-the-counter LithoLyte® and KSPtabsTM on urinary stone risk.
Methods: Ten healthy volunteers without a history of kidney stones were recruited to complete a baseline 24-hour stone risk urinalysis with a four-day diet inventory. Participants were randomized 1:1 to take either LithoLyte® (20 mEq two times per day) or KSPtabsTM (1 tablet two times per day) while maintaining the same diet and submit another 24-hour urinalysis. Finally, the process was repeated with the other supplement. Urinary parameters including citrate, pH and ammonium were compared to baseline. Side effects of each supplement were elicited with a questionnaire after each urine collection.
Results: LithoLyte® intake resulted in a non-significant increase in median citrate (597 to 758 mg/day, p=0.058, an increase in urine pH (6.46 to 6.66, p=0.028), and a decrease in urine ammonium (41 to 36 mmol/day, p=0.005) compared to baseline. KSPtabsTM resulted in an increase in citrate (597 to 797 mg/day, p=0.037) and urine pH (6.46 to 6.86, p=0.037), with a non-significant decrease in ammonium (41 to 34 mmol/day, p=0.059). No significant differences were seen comparing urinary analytes between LithoLyte® and KSPtabsTMsupplements (all p>0.09). With Litholyte®, no side effects, mild, moderate, and severe side effects were seen in 50%, 40%, 10%, and 0%, respectively. With KSPtabsTM, rates were 60%, 20%, 10%, and 10%, respectively. Please see Table 1 and Figure 1.
Conclusions: In healthy participants without a history of kidney stones, LithoLyte® and KSPtabsTM are effective over-the-counter alkali supplements to increase urine pH and citrate excretion. Their side effect profile appears similar to prescription potassium citrate.