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FREQUENTLY ASKED QUESTIONS
	I have long disagreed with folks who recommend to patients with kidney disease use potassium citrate I'd like to try the potassium citrate, I take calcium citrate now. Should I just buy it over the counter? I would like more information on the alkaline diet and its effect on PKD when coupled with Potassium Citrate. I am taking over the counter Potassium Citrate. It says each tablet is: Potassium 99 mg (from 258.6mg Potassium Citrate)....what does that mean? Should I be taking 5 or 6 of these pills a day? I am interested in adding Potassium Citrate to my diet. Any recommendations? Is it safe to take it for long periods or with any other vitamins? I currently take sodium bicarbonate. I am interested in switching to sodium citrate. How do I do this? I am 19y/o with PKD enlarged cystic kidneys. I am interested in potassium citrate and have discussed this with my doctor. He wanted more information on it such as what form you take the supplement in and what dosage levels people usually take. Should we all be taking potassium citrate? Is it a syrup found at a health store? How does potassium citrate effect liver cysts?
There is a new dawn each day

POTASSIUM CITRATE SODIUM CITRATE You will need to work with your doctor before beginning potassium citrate or sodium citrate.

DANGEROUSLY HIGH POTASSIUM SYMPTOMS

Weakness Nausea

Numbness or tingling

Slow pulse. EKG changes done at the doctor's office will show this

Irregular heartbeat

Sudden death

LOW POTASSIUM SYMPTOMS

Cramping & Muscle weakness

Fatigue

Confusion

Difficulties with muscle coordination

Irregular heartbeat

Heart failure

I have long disagreed with folks who recommend to patients with kidney disease use potassium citrate and /or consume large amounts of juiced fruit and vegetables to maintain the correct level of alkalinity. I am worried following this advice will kill some innocent person. My creatinine is 20. I am awaiting a transplant. I have my potassium and base excess carefully monitored by blood work. My doctor prescribes inexpensive sodium bicarb. I have not been able to find any studies that say this increases kidney stone formation.

Potassium rich diets are known to help PKD’rs whereas high sodium diets are detrimental. It is known that alkalinity is helpful for PKD'rs; acidity is not. Why potassium citrate? Thanks to the work of the Tanners we have been given detailed evidence (PKD animal studies) that alkalinity helps diminish PKD cyst growth especially when alkalinity is begun early in life. You are not alone in your opinions.  I would say you are probably in the majority.  Some great minds have preceded you along these very same lines. There are many physicians who agree that as we approach end stage renal disease, sodium bicarbonate is needed.  Others would argue, that while sodium bicarbonate is an effective alkalizer, ailing kidneys might better utilize a citrate alkalizer.  Citrate is used as energy by the kidneys. The body produces many acids and the kidneys fail to clear these acids. In studies produced by the Tanners both citrate and potassium were beneficial to PKD kidneys. It was however the alkalinity in the diet that produced the greatest helpful influence upon kidney cysts. The Tanners published a second paper that concluded alkalinity from either Potassium or Sodium Citrate was equally effective in preventing kidney cyst growth in PKD (animals). Calcium citrate had a mild effect on alkalinity. From these scientific papers we know that alkalinity is the key to maintaining PKD health. Dietary citrate treatment of polycystic kidney disease in rats         “Progression of autosomal-dominant polycystic kidney disease (ADPKD) in the heterozygous male Han: SPRD rat is dramatically slowed by ingestion of potassium or sodium citrate. This study examined the efficacy of delayed therapy with sodium citrate, the effect of sodium citrate therapy”. When I suggested to the late Dr. Mackenzie Walser author of COPING WITH KIDNEY DISEASE, about the possibility of substituting sodium bicarb with sodium citrate he almost inflexibly refused to consider another alkalizer. He could not be persuaded to read any studies about increased kidney stone formation coupled with sodium bicarb. I felt much like Galileo standing before Aristotle (if it were possible. There were 1000 years difference between their two life spans) trying to explain a theory that two objects dropped from a tower will both descend at the same speed. Aristotle's long held theory was that a heavier object (twice as heavy) would fall faster (twice as fast). Aristotle’s theory had withstood for more than 1000 years. Some individuals when asked today would think that Aristotle’s theory was correct though it has been proven false a number of times. For the kidneys there are two specialists: a nephrologist is the medical counterpart; a urologist is the surgeon. There is resistance to prescribing sodium citrate, however it has been used for years to diminish kidney stones. The surgeons, the urologists are most familiar with citrate. Urologists perform lithotripsy surgery to break up kidney stones and have long prescribed potassium – sodium citrate to prevent future stone attacks. Study of potassium citrate treatment of crystalluric nephrolithiasis  [kidney stones]  "After administration of potassium citrate, citric acid and potassium excretion was significantly increased [in the urine.]. Crystals were absent in 12 (71%) out of 17 patients. Calcium excretion in urine was significantly decreased (P < 0.05). A decrease of calcium ions availability to oxalate ions to form calcium oxalate crystals may result in the prevention of calcium oxalate stone formation." Sodium Bicarb is much more familiar to Nephrologists. There is a modern reference to Charles Dickens' Tiny Tim in a Christmas Carol  who may have had kidney disease that was easily correctable.  Tiny Tim's condition, while fatal in one scenario, is reversible when Scrooge pays for medical treatments. Which in those times would likely have included sodium citrate, an alkaline agent that would neutralize the acid in Tiny Tim's blood. Dr. Torres (research nephrologist) published a paper in 1994 showing that acidosis or ammonia was harmful to PKD. Alkalizers were useful, however further studies revealed that PKD animals though helped by sodium bicarb, went on to develop kidney stones.  PKD'rs have a 30% increased risk for developing kidney stones. Most PKD'rs develop calcium kidney stones. It was the Mayo clinic research lab that first looked at alkalizers (sodium bicarbonate) Renal cystic disease and ammoniagenesis in Han:SPRD rats that prompted the Tanners to investigate further, testing another alkalizer; one that would prevent kidney stone formation. This age old tried and true alkalizer was called Shohl's solution or potassium citrate.   Unlike sodium bicarb that increased the risk for kidney stone formation, potassium citrate in Shohl's solutions or sodium citrate in Allbright's solution had been effectively used to prevent future kidney stones. It was explained to me, that with sodium bicarbonate, the bicarbonate ion comes off and hooks up with calcium and becomes calcium carbonate, one of the most common kidney stones. Taking antacids (calcium carbonate) and taking both citrates and bicarbs together increases the risk of kidney stone formation. Citrate lowers uric acid. Uric acids are almost always affected with PKD. Uric acid elevations are most often seen in the urine of PKD'rs. Taking citrates gives an added benefit of decreasing uric acid levels and this decreases the chances for oxalate kidney stone formation and uric acid kidney stone formation. Citrates have been studied further by other medical specialties with clinical trials and these have concluded that potassium citrate lowers blood pressure, increases an athlete's sprinting ability, gives bone strength, corrects the harmful effects of an acid ash diet, reduces yeast infections, and seems to diminish the ever elusive nanobacteria. More articles click here.

I'd like to try the potassium citrate, I take calcium citrate now. Should I just buy it over the counter?

Consult with your physician. Calcium citrate had only a modest effect. Sodium citrate was especially beneficial when started at age 1 month.Your doctor needs to prescribe (Urocit K 5 or Polycitra syrup) Potassium or Sodium Citrate. There are dangers to taking potassium or sodium supplements without a doctor regularly checking your blood work for elevated potassium. I tried the OTC potassium citrate and I had to take 10 tablets to equal one dose of Urocit K or 5 meq of potassium. Once your doc starts you on potassium citrate, get a baseline potassium then once starting prescribed potassium citrate or sodium citrate get a serum potassium blood drawn twice a week, then every week, then every 2 weeks, then once a month, then every 3 months, then every 6 months, and whenever you just do not feel well. Become familiar with high and low potassium symptoms. I am an individual that does not like to pills or medication. I test my urinary pH and supplement with potassium citrate rarely. There are lifestyle changes that adjust pH: long deep breathes about 8 first thing in the morning; walks in nature, surrounding oneself with beauty, a few moments of relaxation i.e. reading, gazing at the setting sun, restorative yoga, gentle exercise, or doing nothing for a few moments, all help diminish stress in your life. I take potassium citrate only when my urinary pH falls below 7.0. Download an abstract from 2003 which talks about calcium citrate.

I would like more information on the alkaline diet and its effect on PKD when coupled with Potassium Citrate At the PKD conference in Arizona, I had the pleasure of meeting two very dedicated scientists - George and Judy Tanner, PKD researchers from the University of Indiana. They had performed very exacting experiments with PKD animals. These animals were fed potassium citrate in their drinking water. The result was that mice fed potassium citrate did not go on to develop huge bubbly cystic kidneys and they lived much longer, approximately 40% longer. There was standing room only in the potassium citrate lecture. George was the speaker. He was introduced by Dr. Chapman from Emory University in Atlanta. His slides clearly showed diminished cyst development on the kidneys of the PKD animals taking potassium citrate, much like the slides in articles written about PKD animals given tolvaptan. This was an incredible find. Here for the first time was PKD medical research backing up what I had experienced within my very own living body. I had been testing my urinary pH with litmus (pH) paper and it was pretty steady at a urinary pH of 6.5 to 7.5. This is not very alkaline. Some might even call this neutral, but usually PKD'rs when they get a urine analysis the urinary pH tests closer to 5. Body acids produced in a PKD’r are oftentimes not fully cleared by cystic kidneys. After publishing this article, the Tanners returned to the laboratory. They wanted to perform further investigations: was it the potassium? Was it the citrate? Or was it something else that diminished cyst growth in the PKD animals? After another round of painstakingly precise experiments, the answer was alkalinity. Potassium citrate is simply a very effective alkalizer. Doctors have used sodium bicarbonate for years. Mackenzie Walser MD from Johns Hopkins is recommending this in his book Coping with Kidney Disease. Other experiments on PKD animals have shown sodium bicarbonate to increase the chances of forming kidney stones. We with PKD already have a 30% increased risk of developing kidney stones. There are some of you who may have a better understanding of this phenomenon. My understanding is that the bicarbonate from sodium bicarbonate,  can spin off and hook up with the calcium ion creating calcium carbonate stones, a very common form of kidney stones found in PKD’rs. Shohl’s solution (potassium citrate) was not only an effective alkalizer; it was also a useful treatment for preventing future attacks from kidney stones. How exciting was all this newly discovered knowledge? It gave me hope that there was something we with PKD could do to increase our chances that we remain among the 40% of PKD’rs who never ever need dialysis or a transplant. What’s more, the solution was not costly.  With a physician’s help, anyone could try it. There are some difficulties in the acceptance of the Tanners’ work. One of the mouse models was worsened by the potassium citrate. The Tanners returned to the laboratory once again, determined to discover why this particular animal model responded in this way. It turns out this PKD animal model has a different kidney disease, perhaps one that allowed them to taste bitter (from the potassium citrate) more sensitively than the other PKD animals. This strain of PKD animals would rather dehydrate themselves than drink bitter potassium citrate tainted water. The Tanners published yet another paper explaining this finding and this PKD animal was given the potassium citrate in the food. There are a few things we know about PKD.   Dehydration can diminish kidney functioning in individuals without any previous kidney disease. The things that worsen PKD are: Dehydration, high sodium diets. Dietary things that help PKD are high potassium diets; a neutral protein intake of 0.7 grams of protein per kilogram of body weight; and on the lifestyle front: gentle exercise,  adequate rest, the absence of stress, and taking the time to lie reclining for some hours all promotes good blood flow to the kidneys. A finding of researchers from CRISP study determined that the first sign of declining kidney functioning was a decrease in renal blood flow – a lessening of the blood perfusing the kidneys. A great thanks to the 100 volunteers who participated in the CRISP study. Armed with this knowledge, we can now go on to test some s not yet released experimental medications that slow down cyst formation in PKD animals. These medications are: tolvaptan, somatostatin, rapamycin and potassium citrate. The kidneys response changes as functioning comes tumbling down. The body’s need for essential amino acids increase. Potassium is not as readily cleared by the kidneys. Additionally certain blood pressure medications cause a rise in the serum potassium. I think this is one of the chief reasons the acceptance for the alkaline diet has been withheld. The same medications that are being tested in the HALT PKD study are the same ones that cause an increase in the blood flow to cystic kidneys, (a good thing) but also these same medications cause the potassium to rise. The HALT medications also cause a lowering of proteinuria (proteins in the urine - an early sign that the kidneys are getting ready to go south). There remains a difficult choice - To maintain a low blood pressure To stop proteinuria To increase renal blood flow or To accomplish all of the above, plus longevity and prolonged renal health by attempting to alkalize the body with potassium citrate. Fortunately for me, I did not have to make this decision. I am very compulsive when it comes to maintaining a healthy body. I monitored blood pressure, tested my urine for proteins and pH. I discovered that if I remained alkaline in the range of 7.0- 7.5 my blood pressure stayed normal low 100/60- 110/70; I did not spill protein in my urine and this is in a 59 year old with ADPKD.  The cardiologists have come across potassium citrate and began a few small clinical trials. It was discovered that potassium citrate could lower blood pressure (in non PKD patients). The urologists found potassium citrate to be useful for more than just diminishing kidney stones. It also was useful in treating generalized candidiasis or yeast infections. Yeast would not over grow when the body was alkaline. They have also used it to treat PNE, pudendal nerve entrapment. Veterinarians have embraced potassium citrate for the treatment of feline PKD and have found a way to have it added to cat chow. Nephrologists are continuing to be watchful about their acceptance of potassium citrate. It is more accepted by nephrologists in poorer countries and island territories such as Guam where the population cannot afford high priced medications. Nephrologists in these areas find transplant and dialysis economically unaffordable have the option to offer their patients inexpensive citrates and essential amino acids to protect kidney functioning. See Saving Kidneys. However the list of nephrologists now prescribing potassium citrate for their patients with PKD in the USA and Europe is increasing. There are a few patients with continuous treatment,who have established documented evidence of diminished cyst growth. This list of doctors willing to treat PKD patients with potassium citrate is steadily growing. There are even several who are treating PKD patients in ESRD end stage renal disease with sodium citrate as opposed to potassium citrate or sodium bicarbonate. I feel the earlier treatment is begun with the alkaline diet, the better, as early as inutero. With early dietary treatment supplemental potassium citrate need not be given as long as the individual continues to maintain alkalinity by testing their urinary alkalinity with pH paper or litmus paper. I foresee a future where individuals with PKD could test urinary pH (much like diabetics tested their urinary sugars) to determine the need for a supplemental alkalizer such as potassium citrate or sodium citrate. Individuals could be taught to recognize the symptoms of high potassium and low potassium (again like a diabetic informed of low sugar symptoms and high). I trust in the integrity of PKD'rs. Though the PKDiet is complicated, many are very willing to attempt the alkaline diet, maintain a neutral protein diet (0.7 grams/kilogram of body weight) and a low sodium diet. Sometimes they fall off the wagon but generally dust themselves and try again because they notice they feel so much better when alkaline. Armed with empirical knowledge, we have found this to be a powerful motivator. I met a physician (nephrologist) from Egypt. He produced a paper that had shown that PKD’rs, who eat 6 dried figs a day, reported they simply felt improved, even while undergoing dialysis. They felt less tired; less depressed and experienced an increase in their energy levels. Dried figs are very alkaline.

I am 19y/o with PKD enlarged cystic kidneys. I am interested in potassium citrate and have discussed this with my doctor. He wanted more information on it such as what form you take the supplement in and what dosage levels people usually take. Download articles on potassium citrate for your doctor. Usually a urinary citrate is done first to see if yours is low. Low urinary citrate is usually found with PKD. Either urocit K or polycitra syrup can be prescribed. One is a tablet; the other a liquid. Both are expensive. However if your physician will monitor your potassium very closely, you might consider an inexpensive form of potassium citrate that can be purchased over the counter. For the equivalent of one urocit K tablet, one would have to take 10 over the counter tablets. When I need to supplement my alkaline diet, I take 5 over the counter tablets no more frequently than twice a week. Your doctor will need to get a baseline serum potassium. In one week check your serum potassium. Then in two weeks. Then once a month. Then once every quarter. Then once every six months, then once a year. It is very helpful if you self test your urinary pH. I use potassium citrate as a supplement to my alkaline diet. Emotions are very strong switch for turning the internal body toward acid. It is for these moments that I take potassium citrate: How I took potassium citrate: Initially I would check my urinary pH every time I urinated. If it was above 7.0 urinary pH , I take no potassium citrate. If it was 6.8 I took a teaspoon of polycitra syrup. If it registered 5, then I would take a tablespoon of Polycitra K. I would take no more than 4 teaspoons daily of potassium citrate or 4 times in a 24 hour day. I am a small woman who usually stays very alkaline. If you are a meat eater and eat many animal products than this may need to be adjusted to a tablespoon, especially if you are a bigger person. I am 5 ft 4 inches about 50 kg or 115 pounds. I think if you self monitor your own blood pressure and your own urinary pH then the alkaline diet supplemented with potassium citrate (or an alkalizer) will help you to maintain an alkaline pH. This will open the doorway toward health. My Diet: I have experienced that a vegan diet without animal proteins (no milk dairy or cheese) is the one that maintains healthy kidneys for the longest time. A vegan diet that eliminates soy, nightshade plants: tomatoes, potatoes, eggplant, peppers, belladonna and tobacco, butter (all animal sources of food), alcohols, yeast, beer, sugars, ale, celery, strawberries, plums, prunes, wheat, white flour, chips, processed foods, canned foods, and a few other fruits and vegetables–seems to be the one which promotes healthy kidneys and liver. I feel really good when I eat this way. I find that lemons easily and quickly change me toward alkaline. For more detailed lists go to: Alkaline diet or Liver lists .




Should we all be taking potassium citrate? Is it a syrup found at a health store? No, this must be done with a doctor closely following your blood potassium levels. The idea here is to become alkaline. My own theory is that we all would do well to stay slightly alkaline. Self monitoring urinary pH allows us to experience how alkaline we are becoming in between doctor visits. There is the danger of in taking potassium citrate. Anyone taking potassium citrate or sodium citrate needs their personal physician to monitor them. High potassium can result in fatal deadly consequences. The risks need to be discussed with your doctor of the highs and lows of potassium. As kidneys decline, we have difficulty with rising potassium levels. Certain blood pressure medications cause serum potassium to rise, such as angiotensin site blockers like Atacand and Cozaar. In the health food store or on the internet, potassium citrate is available as tablets which look similar to an aspirin pill. Polycitra Syrup has to be prescribed and is very useful for diminishing kidney stone formation. It is also known as Shohl's solution. Sometimes I supplement my alkaline diet with 5 over the counter potassium citrate, no more frequently than twice a week. All along I check my urinary pH, a relative alkalinity that gives me an indication how well I am doing. The Urocit equivalent for OTC over the counter potassium citrate is between 9 - 10 tablets. Before starting potassium citrate my doctor ordered a urinary citrate level. This was low, as is to be expected with PKD polycystic kidney disease. I monitored my urinary pH nightly (In the beginning I took it every chance I got to see how it was doing). If my urine ran below 7.0, like 6.8 or 6.5 (green on the test tape) then I took a teaspoon of polycitra. If it was 5.0, then I took a tablespoon of liquid polycitra syrup. At the beginning my serum potassium (blood sample) was tested, then twice a week then my serum potassium was tested once a week, then once every two weeks, then once a month, then once every 3 months and then once every 6 months or anytime I just did not feel well. I was given instruction on symptoms of high and low potassium. I was told to come in and get my potassium checked if I just didn't feel well. There are things your doctor can prescribe to lower serum potassium, if that is a problem. Your medications can also be switched around, should the rise in serum potassium be related to your medications.




How does potassium citrate effect liver cysts? There is no effect on liver cysts from potassium citrate with the animal model. Tolvaptan and rapamycin also have no effect on liver cysts. However somatostatin or Octreotide does diminish liver cyst growth. As long as I have been alkaline, my liver cysts have not grown. To remain alkaline I eliminated all animal foods: dairy, beef, chicken, fish, cheese, yogurt. The digestion of animal proteins triggers the release of acid chyme. It is the acid chyme that triggers secretin flowing and this stimulates cyclic AMP. Cyclic AMP causes cysts to fill with fluid, grow and expand. There are other papers that suggest that citrate is very good for kidney health, even when the kidneys are failing. I have not read these articles but was told about them by a nephrologist in Guam.

POTASSIUM CITRATE ARTICLES and more

Potassium Nutritional breakdown of some common foods
Potassium Dialysis Cookbook
Potassium Foods from fast food restaurant Long John Silver's
Potassium Citrate therapy for PKD in rats by Tanner full article
Potassium Citrate improves renal functioning PKD
Potassium Citrate dietary therapy PKD abstract
Potassium Citrate does not harm PCY mouse