Potassium citrate compliance may be enhanced with sweetener

March 1, 2011

Adding the no-calorie sweetener sucralose (Splenda) to a potassium citrate solution might improve patient compliance with citrate supplementation.

Key Points

The study included 12 healthy individuals with no history of stone disease who received 3-day courses of potassium citrate supplementation, 20 mEq twice daily, using an oral solution prepared with 8 ounces of water with or without one packet of the sweetener. Results from 24-hour urine collections showed urinary citrate increased significantly with use of both regimens and without any significant differences between them in urinary citrate concentration or other urinary parameters.

However, patient ratings, using a visual analog scale, showed the addition of the sweetener significantly improved palatability of the solution and increased the likelihood that patients would be compliant with therapy, researchers from Albany Medical College, Albany, NY, reported at the 2010 World Congress of Endourology and SWL in Chicago.

"Our strategy, which involved mixing the least expensive form of potassium citrate available with water and the sweetener, appears to offer a safe, easy, and economical way to improve the taste of the supplement solution and enable compliance in order to improve prevention of uric acid and calcium oxalate stones."

The study population included equal numbers of men and women who had a mean age of 29 years. They were randomly assigned to begin taking the solution with or without sweetener, and the study included a 1-week washout interval between treatment periods.

Palatability was assessed using a validated Likert scale that asked patients to rate taste and their likely compliance on a scale of 0 (tastes good; the taste would not prohibit me from taking medication) to 10 (tastes terrible; the taste will prohibit me from taking the medication). The taste results showed a 2.5-point difference favoring the potassium citrate solution prepared with the sweetener versus with water alone. The mean score for the sweetened solution was within a range of acceptable taste and compliance, whereas the mean score for the unsweetened solution was indicative that the taste was bad and might decrease compliance.

No effect on citrate excretion, urine pH

The results of the 24-hour urinary analyses not only showed no difference between treatment groups in the efficacy of the oral citrate solutions for increasing citrate excretion, urine pH, and urine potassium, but the changes provided evidence of patient compliance, Dr. Mechlin noted.

He told Urology Times that any no-calorie sweetener would probably improve palatability of the potassium citrate solution and therefore patient compliance. However, he and his colleagues chose sucralose based on a literature search that identified no reports of any adverse effects in humans.

"There was no evidence that sucralose ingestion by humans increases the risk of malignancy, teratogenicity, infertility, or has other toxicity. While other no-calorie sweeteners also have a good safety profile overall, there are rare reports of harmful effects in animal studies," he said.