Published online July 13, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. e300-e304 (doi:10.1542/peds.2009-0217)
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ARTICLE

Empiric Use of Potassium Citrate Reduces Kidney-Stone Incidence With the Ketogenic Diet

Melanie A. McNally, BSa, Paula L. Pyzik, BSb,c, James E. Rubenstein, MDb,c, Rana F. Hamdy, MD, MPHb and Eric H. Kossoff, MDb,c

a School of Medicine, Johns Hopkins University, Baltimore, Maryland
b Departments of Neurology
c Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland

OBJECTIVE: Kidney stones are an adverse event with the ketogenic diet (KD), occurring in ~6% of children who are started on this therapy for intractable epilepsy. Potassium citrate (Polycitra K) is a daily oral supplement that alkalinizes the urine and solubilizes urine calcium, theoretically reducing the risk for kidney stones.

METHODS: Children who started the KD from 2000 to 2008 at Johns Hopkins Hospital, with at least 1 month of follow-up, were evaluated (N = 313). From 2000 to 2005, children were treated with daily Polycitra K at 2 mEq/kg per day only in the setting of identified hypercalciuria, whereas, since 2006, it has been started for all children empirically at KD onset.

RESULTS: Polycitra K was administered to 198 children preventatively overall, 4 (2.0%) of whom developed kidney stones, compared with 11 (10.5%) of 105 who did not receive Polycitra K (P = .003). Two children since 2006 refused Polycitra K, 1 of whom developed a kidney stone. Successful empiric administration of Polycitra K at KD onset resulted in a kidney-stone incidence of 0.9% (1 of 106) compared with administration only because of hypercalciuria, 6.7% (13 of 195; P = .02). Polycitra K resulted in less acidic urine (mean pH: 6.8 vs 6.2; P = .002) but not reduced serum acidosis. No adverse effects of oral citrates were reported.

CONCLUSIONS: Oral potassium citrate is an effective preventive supplement against kidney stones in children who receive the KD, achieving its goal of urine alkalinization. Universal supplementation is warranted.

Key Words: ketogenic • diet • epilepsy • kidney stones • Polycitra

Abbreviations: KD—ketogenic diet

Accepted Mar 24, 2009.


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