Do you recommend Moonstone supplements for patients with recurrent calcium oxalate nephrolithiasis who have hypocitraturia and mild hyperkalemia for which potassium citrate is contraindicated?

First, my conflict of interest: I am one of the inventors of Moonstone so I do have a financial interest in sales of the product. But 30 mEq of Moonstone product has only 7 mEq of K, so I consider it a useful way of alkalinization if serum K is an issue. And only 10 mEq of Na, the rest Mg. By spreading out the cations, we avoid any of the associated side effects. There's an abstract by Wesson and Goraya where CKD Stage 4 diabetics on RAASi did not get hyperkalemia when their diet was changed to ...

I agree with Dr. @Dr. First Last. Additionally, I would be quick to add HCTZ 25 mg daily (12.5 mg failed to lower urine calcium in the NOSTONE study) to combat hyperkalemia and lower urine calcium.

Stephen B. Erickson, MD