Do you prefer starting potassium chloride or amiloride for those with recurrent calcium based nephrolithiasis and hypercalciuria who do not have hypocitraturia but develop hypokalemia following thiazide diuretic initiation?

I prefer potassium citrate, even with normal urinary citrate levels, in urolithiasis patients with hypokalemia. Citrate can be therapeutic for some patients with calcium urolithiasis, and I am not aware of any harm from high urinary citrate levels.

Stephen B. Erickson, MD

I prefer going with Potassium citrate.

I always start with KCl 20 mEq usually BID. My practice leans on reducing diet sodium to make thiazide more effective in lowering urine calcium. I use amiloride when both together prove insufficient.