Efficacy of Potassium Citrate as a Preventive Treatment for Double-J Stent Encrustations

Abstract

Objectives: To evaluate the association between potassium citrate in Double-J (DJ) stent encrustment prevention and compare the incidence of related urinary tract infections (UTI) and crystalluria between patients who use potassium citrate and those who don't use potassium citrate.

Methodology: This prospective cohort study was carried out at the Sindh Institute of Urology and Transplantation. A total of 94 patients requiring DJ stent placement in case of stone disease were enrolled and followed prospectively for 6 weeks. The patients were categorized into two groups. The one group was receiving potassium citrate (60 mEq/day) as prescribed by their respective physicians, and the other group were not receiving potassium citrate. All stents were standardized towards 6 weeks of indwelling. Macroscopic stent encrustation was the major product. Secondary outcomes were crystalluria and UTI incidence. SPSS version 26 was used in the analysis of data (p < 0.05 was taken as significant).

Results: Both potassium citrate and non-potassium citrate patients were having baseline demographics (p<0.05). The macroscopic DJ stent encrustation was much lower in the potassium citrate taking patients than in the non-potassium citrate taking patients (12.8% vs. 36.2; OR 0.26; 95% CI 0.0930.74; p = 0.008). The potassium citrate group demonstrated a significantly lower incidence of crystalluria (17.0% vs. 42.6%; p = 0.007) and UTIs (6.4% vs. 23.4%; p = 0.021). Stratification indicated that the association was significant irrespective of the BMI or diabetic state.

Conclusion: Oral potassium citrate use was associated with a reduced risk of DJ stent encrustation, crystalluria, and UTI. Its regular application ought to be reviewed among the patients who need indwelling ureteral stents for over 6 weeks to limit the morbidity of the stent.

Keywords: Double-J Stent, Encrustation, Potassium Citrate, Urolithiasis, Urinary Tract Infection.