title: Treatment Response in Patients with Stones, and Low Urinary pH and Hypocitraturia Stratified by Body Mass Index.
abstract: OBJECTIVE
  Obesity has been shown to be a risk factor for kidney stone formation. Obesity leads to insulin resistance which subsequently leads to low urinary pH. Low urinary pH is typically treated with potassium citrate. We determined if the response to potassium citrate for the treatment of low urinary pH and hypocitraturia varied when patients were stratified by body mass index.
  
  
  METHODS
  We retrospectively reviewed the records of patients with urolithiasis and concomitant hypocitraturia and low urinary pH as unique abnormalities upon metabolic evaluation treated exclusively with potassium citrate. Based on body mass index the cohort was divided into the 4 groups of normal weight, overweight, obese and morbidly obese. Metabolic data were compared among the 4 groups at baseline and subsequent followup visits up to 2 years. We compared urinary pH and citrate in absolute values and the relative changes in these parameters from baseline. Similarly, we compared the rates of potassium citrate treatment failure.
  
  
  RESULTS
  A total of 125 patients with hypocitraturia and low urinary pH were included in this study. Median patient age was 61 years, 80 patients were male and median body mass index was 30.4 kg/m(2). Patients with a higher body mass index tended to be younger (p=0.010), and had a lower urinary citrate but higher sodium, oxalate and uric acid levels. Urinary pH was similar across body mass index groups. pH values and their absolute changes from baseline were lower as body mass index increased (p ≤0.001). Similarly, we noted an association between increasing body mass index category and lower urinary citrate levels accompanied by a statistically significant trend indicating lower absolute changes in citrate with increasing body mass index (p ≤0.001). Potassium citrate dose was increased more frequently among the higher body mass index groups.
  
  
  CONCLUSIONS
  Patients with a higher body mass index presented with a lower increase in citrate excretion and urinary pH levels after they were started on potassium citrate, and they needed more frequent adjustments to their therapy.
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Urology, Universidad Católica de Chile, Santiago, Chile.
authors.forename: Gaston M
authors.initials: GM
authors.lastname: Astroza
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Urology, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neisius
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matvey
authors.initials: M
authors.lastname: Tsivian
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: Michael.lipkin@duke.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lipkin
mesh_terms: D000368:Aged; D015992:Body Mass Index; D019343:Citric Acid / Q000652:urine; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007669:Kidney Calculi / Q000145:classification / Q000188:drug therapy* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D019357:Potassium Citrate / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019343:Citric Acid; D019357:Potassium Citrate
keywords: body mass index; potassium citrate; urolithiasis