Compendium of the most significant studies with reference to properties, intake, effects.

Sampath A, Kossoff EH, Furth SL, Pyzik PL, Vining EP. Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol. 2007 Apr;22(4):375-8. doi: 10.1177/0883073807301926. 

Abstract. A cohort study was performed of children started on the ketogenic diet for intractable epilepsy from 2000 to 2005 (n = 195). Children who developed kidney stones were compared with those without in terms of demographics, urine laboratory markers, and intervention with urine alkalinization (potassium citrate). Thirteen children (6.7%) developed kidney stones. The use of oral potassium citrate significantly decreased the prevalence of stones (3.2% vs 10.0%, P = .049) and increased the mean time on the ketogenic diet before a stone was first noted (260 vs 149 patient-months, P = .29). The prevalence of kidney stones did not correlate with younger age or use of carbonic anhydrate inhibitors (eg, topiramate or zonisamide) but trended toward higher correlation with the presence of hypercalciuria (92% vs 71%, P = .08). No child stopped the diet due to stones; in fact, the total diet duration was longer (median 26 vs 12 months, P < .001). Kidney stones continue to occur in approximately 1 in 20 children on the ketogenic diet, and no statistically significant risk factors were identified in this cohort. As oral potassium citrate was preventative, prospective studies using this medication empirically are warranted.

McNally MA, Pyzik PL, Rubenstein JE, Hamdy RF, Kossoff EH. Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet. Pediatrics. 2009 Aug;124(2):e300-4. doi: 10.1542/peds.2009-0217. 

Abstract. Objective: Kidney stones are an adverse event with the ketogenic diet (KD), occurring in approximately 6% of children who are started on this therapy for intractable epilepsy. Potassium citrate (Polycitra K) is a daily oral supplement that alkalinizes the urine and solubilizes urine calcium, theoretically reducing the risk for kidney stones.....Conclusions: Oral potassium citrate is an effective preventive supplement against kidney stones in children who receive the KD, achieving its goal of urine alkalinization. Universal supplementation is warranted.

Milliner DS, Harris PC, Sas DJ, Cogal AG, Lieske JC. Primary Hyperoxaluria Type 1. 2002 Jun 19 [updated 2022 Feb 10]. In: Adam MP, Everman DB, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2022.

Abstract. Clinical characteristics: Primary hyperoxaluria type 1 (PH1) is caused by a deficiency of the liver peroxisomal enzyme alanine:glyoxylate-aminotransferase (AGT), which catalyzes the conversion of glyoxylate to glycine. When AGT activity is absent, glyoxylate is converted to oxalate, which forms insoluble calcium oxalate crystals that accumulate in the kidney and other organs. Individuals with PH1 are at risk for recurrent nephrolithiasis (deposition of calcium oxalate in the renal pelvis / urinary tract), nephrocalcinosis (deposition of calcium oxalate in the renal parenchyma), or end-stage renal disease (ESRD). Age at onset of symptoms ranges from infancy to the sixth decade. Approximately 10% of affected individuals present in infancy or early childhood with nephrocalcinosis, with or without nephrolithiasis, and failure to thrive related to renal failure. The majority of individuals with PH1 present in childhood or early adolescence, usually with symptomatic nephrolithiasis and normal or reduced kidney function. The remainder of affected individuals present in adulthood with recurrent renal stones and a mild-to-moderate reduction in kidney function. The natural history of untreated PH1 is one of progressive decline in renal function as a result of calcium oxalate deposits in kidney tissue and complications of nephrolithiasis (e.g., obstruction and infection) with eventual progression to oxalosis (widespread tissue deposition of calcium oxalate) and death from ESRD and/or complications of oxalosis.....Strategies to minimize calcium oxalate crystal and stone formation by reducing urinary calcium oxalate supersaturation include: high oral fluid intake; alkalization of the urine using oral potassium citrate; and/or oral solutions that increase urinary pyrophosphate. Copyright © 1993-2022, University of Washington, Seattle.

Chesters R, Kaufman HW, Wolff MS, Huntington E, Kleinberg I. Use of multiple sensitivity measurements and logit statistical analysis to assess the effectiveness of a potassium-citrate-containing dentifrice in reducing dentinal hypersensitivity. J Clin Periodontol. 1992 Apr;19(4):256-61. doi: 10.1111/j.1600-051x.1992.tb00463.x. 

Abstract. A potassium citrate-SMFP containing dentifrice was tested in a double-blind 8-week clinical trial on subjects with a history of dentinal hypersensitivity. A dentifrice containing SMFP but no potassium salt was used as the control and a 2nd test dentifrice containing potassium nitrate-SMFP was assessed at the same time. The sensitivity of the subjects was evaluated at 0, 3 and 8 weeks using electrical and tactile methods plus a 1-s air blast. The sensitivity scores for each subject at each examination were summarised as a proportion of the examined teeth deemed sensitive. Assessment of any effects of the dentifrices was via an analysis of covariance of the logit transformation of these proportions with the baseline value as the covariate. The use of this novel method of analysis had the advantage of taking into account changes in sensitivity of all of the teeth, both sensitive and non-sensitive, since electrical measurements indicated effects on both. Of the original 120 subjects, 111 completed the trial and the 3 dentifrice groups remained well balanced for age, sex and sensitivity. All 3 dentifrice groups showed statistically significant reductions in sensitivity over the 8 weeks. However, the potassium citrate-SMFP dentifrice was significantly more effective than either the control SMFP dentifrice, or the potassium nitrate-SMFP dentifrice, at reducing sensitivity after 3 weeks, and this difference plus further sensitivity reduction with all 3 dentifrices was observed after 8 weeks.

Hu D, Zhang YP, Chaknis P, Petrone ME, Volpe AR, DeVizio W. Comparative investigation of the desensitizing efficacy of a new dentifrice containing 5.5% potassium citrate: an eight-week clinical study. J Clin Dent. 2004;15(1):6-10.

Abstract. Objective: This double-blind clinical study was designed to investigate the relative effectiveness of a new desensitizing test dentifrice containing 5.5% potassium citrate, 1.14% sodium monofluorophosphate (MFP) and 10% high-cleaning silica (HCS) in a silica base for reducing dentinal hypersensitivity over an eight-week period, to that of a commercially available desensitizing positive control dentifrice containing 3.75% potassium chloride, 0.32% sodium fluoride and 0.3% triclosan in a silica base....Conclusion: The results of this double-blind clinical study indicate that the use of a commercially available test dentifrice containing 5.5% potassium citrate, 1.14% sodium monofluorophosphate and 10% high-cleaning silica in a silica base demonstrates no statistically significant difference in tactile and air blast sensitivity compared to the commercially available desensitizing positive control dentifrice containing 3.75% potassium chloride, 0.32% sodium fluoride and 0.3% triclosan in a silica base.