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Citrate, Malate and Alkali Content in Commonly Consumed Diet Sodas: Implications for Nephrolithiasis Treatment

2010; Lippincott Williams & Wilkins; Volume: 183; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2010.02.2388

1527-3792

Brian H. Eisner, John R. Asplin, David S. Goldfarb, Ardalan E. Ahmad, Marshall L. Stoller,

Pediatric Urology and Nephrology Studies

No AccessJournal of UrologyInvestigative Urology1 Jun 2010Citrate, Malate and Alkali Content in Commonly Consumed Diet Sodas: Implications for Nephrolithiasis Treatment Brian H. Eisner, John R. Asplin, David S. Goldfarb, Ardalanejaz Ahmad, and Marshall L. Stoller Brian H. EisnerBrian H. Eisner Department of Urology, University of California-San Francisco, San Francisco, California Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , John R. AsplinJohn R. Asplin Litholink Corp., Chicago, Illinois, and Nephrology Section, New York Harbor Veterans Affairs Medical Center, New York, New York , David S. GoldfarbDavid S. Goldfarb Department of Urology, St. Vincent's Hospital and New York University School of Medicine, New York, New York , Ardalanejaz AhmadArdalanejaz Ahmad Department of Urology, University of California-San Francisco, San Francisco, California , and Marshall L. StollerMarshall L. Stoller Department of Urology, University of California-San Francisco, San Francisco, California View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2388AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Citrate is a known inhibitor of calcium stone formation. Dietary citrate and alkali intake may have an effect on citraturia. Increasing alkali intake also increases urine pH, which can help prevent uric acid stones. We determined citrate, malate and total alkali concentrations in commonly consumed diet sodas to help direct dietary recommendations in patients with hypocitraturic calcium or uric acid nephrolithiasis. Materials and Methods: Citrate and malate were measured in a lemonade beverage commonly used to treat hypocitraturic calcium nephrolithiasis and in 15 diet sodas. Anions were measured by ion chromatography. The pH of each beverage was measured to allow calculation of the unprotonated anion concentration using the known pK of citric and malic acid. Total alkali equivalents were calculated for each beverage. Statistical analysis was done using Pearson's correlation coefficient. Results: Several sodas contained an amount of citrate equal to or greater than that of alkali and total alkali as a lemonade beverage commonly used to treat hypocitraturic calcium nephrolithiasis (6.30 mEq/l citrate as alkali and 6.30 as total alkali). These sodas were Diet Sunkist® Orange, Diet 7Up®, Sprite Zero™, Diet Canada Dry® Ginger Ale, Sierra Mist® Free, Diet Orange Crush®, Fresca® and Diet Mountain Dew®. Colas, including Caffeine Free Diet Coke®, Coke Zero™, Caffeine Free Diet Pepsi® and Diet Coke with Lime, had the lowest total alkali (less than 1.0 mEq/l). There was no significant correlation between beverage pH and total alkali content. Conclusions: Several commonly consumed diet sodas contain moderate amounts of citrate as alkali and total alkali. This information is helpful for dietary recommendations in patients with calcium nephrolithiasis, specifically those with hypocitraturia. It may also be useful in patients with low urine pH and uric acid stones. Beverage malate content is also important since malate ingestion increases the total alkali delivered, which in turn augments citraturia and increases urine pH. References 1 : Is citrate an inhibitor of calcium oxalate crystal growth in high concentrations of urine?. Urol Res1996; 24: 67. Google Scholar 2 : Low urinary citrate excretion in nephrolithiasis. Urology1983; 21: 8. Crossref, Medline, Google Scholar 3 : Hypocitraturia in calcium nephrolithiasis. J Clin Endocrinol Metab1982; 55: 1052. Google Scholar 4 : Update on the medical management of stone disease. Curr Opin Urol2009; 19: 200. 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Eisner Department of Urology, University of California-San Francisco, San Francisco, California Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Financial interest and/or other relationship with Boston Scientific, PercSys and Ravine Group. More articles by this author John R. Asplin Litholink Corp., Chicago, Illinois, and Nephrology Section, New York Harbor Veterans Affairs Medical Center, New York, New York Financial interest and/or other relationship with Ravine Group. More articles by this author David S. Goldfarb Department of Urology, St. Vincent's Hospital and New York University School of Medicine, New York, New York Financial interest and/or other relationship with Ravine Group. More articles by this author Ardalanejaz Ahmad Department of Urology, University of California-San Francisco, San Francisco, California More articles by this author Marshall L. Stoller Department of Urology, University of California-San Francisco, San Francisco, California Financial interest and/or other relationship with PercSys and Ravine Group. More articles by this author Expand All Advertisement PDF downloadLoading ...