Kidney stones can cause intense pain and lead to serious health problems if not treated. These hard mineral deposits form when substances like calcium, oxalate, and uric acid build up in the urine and crystallize.

Dehydration, high sodium intake, and certain medical conditions, such as renal tubular acidosis, can raise the risk of stone formation. Potassium citrate therapy is a well-studied treatment that helps prevent certain types of kidney stones by increasing urinary citrate and raising urine pH.

This guide explains how potassium citrate can prevent and treat kidney stones effectively.

Kidney stones can affect anyone, but some people are more likely to develop them due to certain health and lifestyle factors. Understanding what causes these painful stones is the first step in stopping them before they start.

Kidney stones, also known as renal calculi, are hard mineral deposits that form when concentrated urine causes minerals to crystallize and stick together. The most common types include:

• Calcium oxalate stones – often linked to high urinary calcium and oxalate

• Calcium phosphate stones – typically form in urine with a higher urinary pH

• Uric acid stones – more likely to develop in urine with persistently low urinary pH

• Cystine stones – rare and caused by a genetic condition called cystinuria, which affects cystine handling in the kidneys

The type of kidney stone depends on the minerals in the urine and conditions like urinary pH, urine volume, and the levels of substances such as calcium, oxalate, and uric acid. Stones can be of different sizes and shapes, and they often cause sharp pain as they move through the urinary tract. Without proper treatment, they can lead to complications like urinary tract infections, ureteral blockage, or severe renal colic.

Kidney stones often develop when the balance of minerals and compounds in the urine is disrupted. These changes can lead to crystal formation and increase the risk of stone growth. Common causes include:

• Low urine volume, which concentrates minerals and makes crystal formation more likely

• High urinary calcium, which contributes to calcium oxalate and calcium phosphate stones

• Excess urinary oxalate, often from certain foods or internal metabolic processes

• Low urinary citrate excretion, which reduces the body’s natural ability to prevent crystal formation

• High-salt or high-protein diets, which can increase calcium excretion and reduce urinary citrate levels

• Renal tubular acidosis, a condition that affects acid levels and can lead to calcium phosphate stones

• Idiopathic hypocitraturia calcium nephrolithiasis, a condition involving low urinary citrate without an identifiable cause

• Low urinary pH, which increases the risk of forming uric acid stones

• Increased urinary supersaturation, which promotes the crystallization of stone-forming substances

Urinary stone recurrence can harm kidney tissue and increase the risk of chronic kidney disease, especially when urinary tract infections are also present. Stones often return if no preventive steps are taken. Early prevention through medical treatment and lifestyle changes can help reduce the risk of long-term kidney problems.

Potassium citrate is often used to help manage stone risk by changing urine chemistry. It helps maintain the proper chemical balance, especially for those who form calcium or uric acid stones.

Potassium citrate is a type of potassium salt made by combining potassium with citric acid, a natural substance found in citrus fruits like lemons and oranges. It works by making the urine more alkaline. This helps correct imbalances between stone-forming substances like oxalate and calcium, while increasing protective citrate levels and lowering calcium ion activity. As a result, it's harder for stone-forming crystals to clump together and form kidney stones.

Uric acid stones often form when urine is too acidic. Potassium citrate helps raise urine pH, making the urine more alkaline. This increases the solubility of uric acid and lowers the risk of uric acid lithiasis, a condition where uric acid crystals form stones in the urinary tract. By improving urine pH, potassium citrate helps prevent new stones from forming and slows the growth of existing ones.

Some people have low urine citrate, which raises the risk of forming calcium-containing stones. Potassium citrate helps increase urinary citrate excretion, which binds to calcium in the urine and makes it harder for stones to form. This can lower the risk of calcium oxalate and calcium phosphate stones.

Clinical studies suggest that potassium citrate may also help reduce recurrence in calcium stone formers and support the management of calcium nephrolithiasis, a condition where calcium-based stones form in the kidneys.

Using potassium citrate correctly is essential for it to work effectively. The form, timing, and dose can vary depending on your needs and health condition.

Potassium citrate is available in tablet, powder, and liquid forms. The starting dose usually depends on your urine pH, urine citrate levels, and the type of kidney stone you have. Your doctor may adjust the dosage based on urine test results to help lower calcium excretion and raise urinary citrate levels.

Doctors often recommend taking potassium citrate with meals to help reduce stomach discomfort. It’s important to take it at the same time each day to keep urine citrate and pH levels steady for the best results.

While potassium citrate is effective for preventing and treating kidney stones, it may cause side effects in some people. These effects are usually mild and can often be managed with simple adjustments.

Here’s how to reduce the risk of side effects during treatment:

• Take potassium citrate with food or after meals to minimize stomach upset and nausea.

• Stay well-hydrated to support urine volume and ease gastrointestinal symptoms like bloating or gas.

• Avoid high-sodium foods such as processed snacks and table salt (sodium chloride), which can increase recurrent stone formation.

• Use potassium-sparing diuretics only under medical supervision to avoid dangerously high potassium levels.

• Ask your doctor about regular blood tests to monitor serum calcium and urinary potassium for any imbalances.

• Report symptoms like muscle weakness, tingling, or irregular heartbeat to your healthcare provider, as they may signal a need to adjust your dosage.

Potassium citrate therapy works best when combined with healthy daily habits. Simple changes can significantly reduce your risk of stone formation.

Making smart food choices can help prevent kidney stones and improve the effects of potassium citrate. Certain nutrients and eating habits can either raise or lower your risk, depending on how they affect urine composition. Here are key dietary changes to consider:

• Limit high-oxalate foods like spinach, beets, nuts, chocolate, and sweet potatoes.

• Reduce sodium intake to lower urinary calcium and stone risk.

• Cut back on animal protein to reduce urinary uric acid and support urine citrate levels.

• Get calcium from food to help bind oxalate in the gut and reduce urinary oxalate levels.

• Avoid excess vitamin C, which can raise oxalate levels.

• Eat more low-oxalate fruits and vegetables to boost urinary citrate and support alkaline urine.

Drinking enough water increases the amount of urine, helps increase urinary pH, and dilutes stone-forming substances. It also supports the body’s ability to regulate oxalate levels, which can lower the risk of calcium oxalate stones. Aim for at least 2 to 3 liters of fluid daily to prevent low urine pH and reduce urinary supersaturation of stone-forming minerals.

In addition to diet and hydration, certain lifestyle habits can help reduce the risk of recurrent kidney stones. These changes support better urinary health and make potassium citrate more effective. Consider the following:

• Stay physically active to support kidney function, improve urinary flow, and help regulate body weight.

• Maintain a healthy weight since obesity is linked to lower urine pH and a higher risk of renal stone disease.

• Limit high-sodium foods like processed snacks and fast food to reduce urinary calcium and calcium ion activity.

• Avoid excessive animal protein, which can increase urinary uric acid and reduce urine citrate levels.

• Get enough dietary calcium from food, not supplements, to bind oxalate in the gut and lower calcium stone risk.

• Work with a healthcare provider to monitor for metabolic abnormalities that may increase the risk of recurrent stones.

Potassium citrate is sometimes used to support the treatment of existing renal stones. It may also help reduce the risk of recurrence.

Doctors often include potassium citrate in the treatment plan for people with recurring stone disease. It’s especially useful for those with metabolic abnormalities, low urinary citrate, high urinary uric acid excretion, or a history of kidney stones. Regular use may help lower the risk of stone recurrence and support long-term kidney health.

During potassium citrate therapy, your doctor will closely monitor how your body responds to the treatment. This helps ensure the dosage is working correctly and prevents complications. You can expect the following during treatment:

• Regular 24-hour urine tests to measure urine pH, urinary citrate, and other key markers related to stone risk

• Monitoring urine calcium and urinary oxalate levels to evaluate the risk of calcium stone recurrence.

• Urinary sodium checks to see if salt intake is increasing calcium excretion

• Tracking urinary volume to confirm you're drinking enough fluids to dilute stone-forming substances

• Periodic blood tests to check serum calcium and potassium levels and ensure safe potassium citrate use

• Ongoing dosage adjustments based on lab results and changes in stone risk factors

• Follow-up visits to review symptoms, discuss progress, and update your treatment plan as needed

Some stone-forming patients have reported fewer stone episodes and reduced discomfort while using potassium citrate as part of their treatment plan. Others have experienced complete stone passage or smaller stone sizes. Potassium citrate also reportedly improved their oxalate and citrate homeostasis, supported proper renal excretion, and lowered urine calcium excretion, making them less likely to develop new stones. It also helped regulate their urinary potassium levels and has reportedly shown a positive effect on bone mineral density.

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Potassium citrate plays an important role in preventing and managing kidney stones by increasing urinary citrate, lowering urine calcium, and helping maintain a healthy urine pH. This combination can reduce the risk of forming calcium oxalate, calcium phosphate, and uric acid stones while supporting long-term kidney health. When combined with lifestyle changes such as a low-oxalate diet, proper hydration, and weight management, potassium citrate therapy may help lower the risk of recurrent stones. Always consult a healthcare provider before starting potassium citrate or making major dietary changes to ensure the approach is safe and appropriate for your needs.

The information provided in this article is for educational and informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider before starting any new dietary supplement, especially if you are pregnant, nursing, have a medical condition, or are taking other medications. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

1. Ferraro, P. M., Curhan, G. C., Gambaro, G., & Taylor, E. N. (2016). Total, Dietary, and Supplemental Vitamin C Intake and Risk of Incident Kidney Stones. American journal of kidney diseases: the official journal of the National Kidney Foundation, 67(3), 400–407. https://doi.org/10.1053/j.ajkd.2015.09.005

2. Pak, C. Y., & Fuller, C. (1986). Idiopathic hypocitraturic calcium-oxalate nephrolithiasis successfully treated with potassium citrate. Annals of internal medicine, 104(1), 33–37. https://doi.org/10.7326/0003-4819-104-1-33

3. Sadiq, S., & Cil, O. (2022). Cystinuria: An Overview of Diagnosis and Medical Management. Turkish archives of pediatrics, 57(4), 377–384. https://doi.org/10.5152/TurkArchPediatr.2022.22105

4. Wiegand, A., Fischer, G., Seeger, H., Fuster, D., Dhayat, N., Bonny, O., Ernandez, T., Kim, M. J., Wagner, C. A., & Mohebbi, N. (2019). Impact of potassium citrate on urinary risk profile, glucose and lipid metabolism of kidney stone formers in Switzerland. Clinical kidney journal, 13(6), 1037–1048. https://doi.org/10.1093/ckj/sfz098