The Effectiveness of Lemon Solution versus Potassium Citrate in the Management of Hypocitraturic Calcium Kidney Stones: A Systematic Review.

Review Questions/Objectives The objective of this systematic review is to critically analyse the quantitative research studies and present the best available evidence related to the effectiveness of lemon solution compared with the effectiveness of potassium citrate in the management of hypocitraturic calcium kidney stones for adults. The more specific review question is: Is lemon solution as effective as potassium citrate in the management of hypocitraturic calcium kidney stones for adults? Types of participants The participants of interest include adult and elderly patients who are 18 years or above. There is no limitation with gender, ethnicity, and settings. Patients who are required to have surgical intervention or have acute symptoms such as acute pain, obstruction, bleeding, and severe infection are also included. Participants are diagnosed with the types of calcium oxalate and/or calcium phosphate kidney stones based on stone analysis and presenting total daily urinary citrate excretion of less than 320 mg or 500 mg. Other diagnostic methods for stone analysis are specified by research investigators will be included. Types of interventions The intervention of interest is lemon solution in the management of hypocitraturic calcium kidney stones. For instance, lemon solution includes commercial beverages of lemonade, and using fresh lemon juice with water only and/or sugar. Approximately 85cc of lemon juice contains 60 mEq (4.2 gm) citrate. The daily dose of lemons’ citrate is given as equal as comparator-potassium citrate. Nursing staff daily make a jug of lemon water (1,000ml - 2,000ml) and delivery to participants. The participants have to finish the jug of lemon water in 24 hours. Lemon water also can be delivered as a single serve (e.g. 250-350 ml) after 3 meals. Participants in communities or homes are trained to administrate this intervention. Types of comparator The comparator is the drug intervention of potassium citrate administered orally in the management of hypocitraturic calcium kidney stones. A typical dose of potassium citrate for adults is from 40 to 60 mEq daily. The dose of potassium citrate can be increased or decreased based on inpatient monitored changes in urinary citrate level. Nursing staff daily delivery TRUNCATED AT 350 WORDS