Interdisciplinary therapeutic application of potassium citrate in internal diseases

摘要

Citrates share both metabolic and excretory role. Through Krebs-cycle conversion they stimulate blood alkalization with biochemical-hormonal effects depending from the accompanying cation. The excretory function covers inhibition of calcium oxalate (COM) and uric acid (UA) aggregation in urine, reduction of calciuria. Citriaturia depends on acid-base equilibrium, diet, accompanying diseases and their treatment. Hypocitriaturia is defined as excretion of less than 320 mg/24h. It is found in tubular acidosis t.1, in 76-87% cases of calcium stones, in 40% of UA stone disease, in 30% cases of kidney stones with osteopenia. Potassium citrate (K3Cit) reduces urinary COM saturation, has good citriaturic effect. K3Cit increases effectiveness of thiazide treatment of calcium stone disease with osteopenia. In metabolic syndrome COM and UA saturation raise much more than cytriaturia. A metabolic acidosis in t.2 diabetes (DM2) induces hypocytriaturia and raises a risk of UA stone disease. Growing-up body mass index reduces citriaturic effect of K3Cit. In DM2 K3Cit reduces stone morbidity, reverses negative base equilibrium and increases insulin sensitivity. High K3Cit doses increase general lumbar bone mass and reduce bone resorption activity. In chronic interstitial nephropathies K3Cit slow down GFR decline. Slow releasing formulas of K3Cit and other citrates in accordance to precise indications should be elements of therapeutic regimen of calcium (i.e.: COM) or UA stone diseases, metabolic syndrome, osteopenia and chronic (interstitial) nephropathies. Profits are limited by the hydration status of patient and his/her motivation to long lasting treatment. The interdisciplinary usefulness of K3Cit may improve cost/effect ratio of treatment.