This study found that among stone-free patients, 8% of treated patients and 42% of untreated patients developed composite stone recurrence with Relative Risk (RR) of 0.19 and Confidence Interval (CI) of 0.01 to 1.28. Meanwhile, among residual fragments patients, 7% of treated patients and 55% of untreated patients developed composite stone recurrence with RR, 0.3 [CI, 0.08 to 1.0]. Thus, it indicated patients in treated group have a lower risk to develop RN compared to non-treated patients.
There is no allocation concealment of patients and blinding stated, therefore bias would be concerned in this study. Besides, the presence of sodium content in the drug might cause the rise of calcium excretion that is not solely support the result. In the meantime, recurrence prevention therapies were tone down due to the enthusiasm to use modern devices and its efficacious rate in stone removal field, nevertheless the result in this paper highlighted how valuable the pharmacological treatment is.
Another retrospective study by Robinson et al. hypothesized that KCit can cause significant outcomes on urinary metabolic profiles and halt the rate of stone formation. 503 patients recruited were divided into 2 subsets; 264 patients complied with KCit medication only, and the other complied with multiple medications such as thiazide or allopurinol. The pre-KCit and post-KCit urinary metabolic profiles were compared, and the stone formation rate was calculated along the follow-up period of 6 to 168 months.
The result complements to Lojanapiwat’s study that subset with KCit alone showed urinary citrate increased from (435 ± 329) mg to (711 ± 380) mg per day, while urinary pH increased from (5.93 ± 0.49) to (6.40 ± 0.55). The decrease of stone formation rate recorded was from 1.22 to 0.19 stones per year (p < 0.0001). Latter, 68% of the study population had shown complete remission of stone formation. Therefore, the association of KCit (either alone or combined with other pharmacological therapy) displayed the same result as other studies [10-12]
This paper did not highlighted any adverse effect of drug used, the long term compliance shown by the patients which is up to 168 months, however, reflected that there is less side effect of it. Moreover, that long-term compliance from patients also suggested that KCit effect was truly durable and not wanes over time. This long term review and big sample population increase the consistency of the data and can generalize it into a wider population. Besides, most of the patients in this study population used CT technologies to detect new stone formation or stone growth, thus it was likely to have more sensitivity in detecting small fragments compared to other devices. Nevertheless, the retrospective nature of this study causes concern in the selection bias of study population.
Moreover, studies done by Penniston and Tosukhowong et al. have already proved the efficacy of alkaline citrate. In which, the used to KCit...