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Submitted on July 12, 2004
Accepted on November 18, 2004
Department of Medicine and General Clinical Research Center; UCSF
* To whom correspondence should be addressed.
Lynda Frassetto, E-mail: frassett{at}gcrc.ucsf.edu
Purpose: Potassium bicarbonate (KBC) potently reduces urine calcium excretion in adult humans, including patients with hypertension or calcium urolithiasis, and postmenopausal women. In the latter, who have substantial risk of calcium deficiency, it remains unknown whether the observed short-term urine calcium-lowering effect of KBC persists over years.
Methods: We studied 170 postmenopausal women randomized to KBC 30, 60, 90 mmol/day (KBC-treatment), or placebo, for up to 36 months. Each received a multivitamin with 400 IU vitamin D, and calcium carbonate as needed to produce a total dietary calcium intake of at least 300 mmol daily.
Results: Daily urine calcium excretion (UCaV) did not differ among groups at baseline (all-groups mean±SD, 155 ± 83 mg/d). From 1 to 36 months of KBC-treatment, adjusting UCaV for creatinine (Cr) excretion, each dose of KBC reduced in urinary calcium (UCaV), (P < 0.01), with a dose-dependent trend (P = 0.05). The reduced UCaV/Cr persisted throughout the KBC-treatment period (up to 36 months) in all KBC, and the greatest reductions occurred in the subjects with greatest baseline UCaV/Cr (
UCaV/Cr vs. Baseline UCaV/Cr, P < 0.001).
Twenty-eight % of the subjects had high baseline calciuria [(UCaV/Cr > 200 mg Ca/1000 mg Cr). With baseline UCaV/Cr of 250 mg/1000 mg Cr, KBC 60 mmol decreased UCaV/Cr by 55.8 mg/1000 mg Cr, a potential daily calcium retention that over a 36 month period would accumulate to some 55,845 mg of calcium-- nearly 5% of bone calcium content.
Conclusion: KBC treatment induced a dose-dependent decrease in UCaV/Cr that persisted up to 36 months, with the greatest decreases occurring in those women with the greatest baseline urine calcium excretion, nearly a third of whom had high baseline calciuria. Thus, one can pre-select postmenopausal women most likely to have the urine calcium-lowering effect of KBC, and predict their potential bone calcium increase.
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