Potassium citrate—many are on it, many more might benefit from it. To see if this little pill is a good addition to YOUR kidney stone prevention tool kit, get a 24-hour urine collection—it’ll tell you everything you need to know.
What does potassium citrate do?
When you take potassium citrate, your body turns it into something called bicarbonate which helps to make your urine less acidic.
Why does this matter?
This matters because certain types of stones—uric acid stones and calcium oxalate stones—thrive in acidic urine. Potassium citrate helps alkalize your urine (raising your urine pH), making it harder for those stones to form. It also helps increase urinary citrate, which binds to calcium and keeps stones from growing. If calcium has this protective shield (citrate) then oxalate and phosphate will not bind to it. This will lower your kidney stone risk.
Why would someone need this pill in the first place?
Here are a few reasons why:
Low urine citrate (called hypocitraturia): This is a common reason doctors prescribe potassium citrate. You won’t know your citrate level without a 24-hour urine collection; get one ordered!
Acidic urine: Some people naturally run acidic. Others may eat a diet high in animal protein or low in fruits and vegetables, making their urine more acidic. Potassium citrate helps balance that and dietary changes that increase fruits and veggies.
Frequent uric acid stones: These stones thrive in acidic urine. Potassium citrate can help dissolve uric acid crystals before they form into stones. The only stones that can be dissolved are uric acid stones.
People on high-protein, low-carb diets: Think keto or carnivore-type plans. These can lower urine pH and citrate levels. You may need extra support if you’re not balancing that out with fruits and vegetables.
Medical conditions: Conditions such as chronic diarrhea (IBS, IBD, Crohn’s, Ulcerative Colitis), certain types of kidney disease, or metabolic acidosis can all lead to lower urinary citrate and higher risk for kidney stones.
If you’re on a diuretic: Your doctor might add potassium citrate if you’re taking a diuretic. Some diuretics lower potassium and make urine more acidic—both can raise stone risk. Potassium citrate helps correct that by replacing lost potassium and making urine more alkaline, which helps prevent certain types of stones.
Potassium citrate is not for everyone, and it’s not something you take “just in case.” So, if your doctor suggests potassium citrate, it’s based on your urine test results and medical history.
Don’t forget: potassium citrate works best alongside your lifestyle changes. That means sticking to your Kidney Stone Diet® Goals—watching sodium, getting enough calcium, drinking water, and “portion, not perfection.” Even though your doctor may prescribe pills to help you, the Kidney Stone Diet® must also be followed.
Ask Nurse Jill
Q: Do I really have to take this pill forever?
A: Not always! For some people, potassium citrate is a short-term tool while they work on lifestyle changes. For others, it’s needed for a longer term. That’s why regular 24-hour urine testing is so important—you want to make sure it’s still necessary and working for you.
Q: What are some natural ways to increase my citrate and urine pH?
A: Fruits and veggies will help. But to only some degree. Some of you will need to get more of a bump and be prescribed potassium citrate to achieve the desired outcome.
Q: What about lemons? I heard they can help.
A: Lemons can only bump up your citrate and or pH slightly. It is often not enough to give you the protection you may need. Again, you must do a urine collection to see if you need lemon or potassium citrate.
Q: I am taking potassium citrate but not absorbing it. I see the pill in the toilet.
A: You most likely are seeing the encapsulation or coating of the pill. Do not worry; you are absorbing it. This is very common.
Q: The pills give me acid reflux and/or diarrhea. Is this normal?
A: This is a fairly common side effect. Please speak to your doctor to recommend something else to help if you can not tolerate potassium citrate or lessen the prescribed dose.
Learn what your 24-hour urine test results mean for you?
These reports can be confusing but they’re key to your kidney stone prevention plan. I’ll walk you through your results and how to use them for a productive doctor’s office visit.
Your friend,
Nurse Jill
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