title: Does citrate prevent nephrocalcinosis in preterm neonates?
abstract: Nephrocalcinosis (NC) occurs frequently in preterm neonates. A high U-calcium/citrate is one of the contributing factors to the development of NC. In stone-forming children and adults citrate supplementation is a successful preventive therapy. In this randomized controlled trial the effect of citrate therapy was studied on the development of NC in preterm neonates with a gestational age <32 weeks. Thirty-eight preterm neonates (mean gestational age 29.8 weeks (SD 1.6), mean birth weight 1,300 g (SD 351) were treated with sodium citrate (0.52 mmol/kg/day in four doses) from day 8 of life until at term and 36 preterm neonates (mean gestational age 29.6 weeks (SD 1.6), mean birth weight 1,282 g (SD 256) were not treated. U-calcium, U-creatinine, U-citrate and U-pH were measured at day 7, 14, 21, 28 of life and at term. Renal ultrasonography (US) was performed at term. U-citrate/creatinine and U-pH were significantly higher and U-calcium/citrate was significantly lower in the citrate group at day 14, 21 and 28 compared with the control group (P<0.05). Complications of citrate administration were not encountered, however the incidence of NC was not significantly different in the treated (34%) compared with the control group (44%), P=0.37. Preterm neonates treated with citrate in the first months of life have higher U-citrate/creatinine and lower U-calcium/citrate compared with controls. Sodium citrate therapy in a dosage of 0.52 mmol/kg/day is safe but does not prevent NC. Whether a higher dose or potassium citrate decreases the incidence of NC should be evaluated in further studies.
authors.affiliation: Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Eveline A
authors.initials: EA
authors.lastname: Schell-Feith
authors.forename: Aukje
authors.initials: A
authors.lastname: Moerdijk
authors.forename: Paul H T
authors.initials: PH
authors.lastname: van Zwieten
authors.forename: Harmine M
authors.initials: HM
authors.lastname: Zonderland
authors.forename: Herma C
authors.initials: HC
authors.lastname: Holscher
authors.forename: Joana
authors.initials: J
authors.lastname: Kist-van Holthe
authors.forename: Bert J
authors.initials: BJ
authors.lastname: van der Heijden
mesh_terms: D019343:Citric Acid / Q000494:pharmacology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D009397:Nephrocalcinosis / Q000517:prevention & control*
chemical_list: D019343:Citric Acid