Efficacy of Potassium Citrate as a Treatment for Metabolic Acidosis in Cats with Chronic Kidney Disease

The University of Florida College of Veterinary Medicine is currently recruiting cats with kidney disease for a clinical trial evaluating potassium citrate and gluconate supplementation for treatment of metabolic acidosis.  This information may be able to be used in the future to direct specific therapies in cats with CKD and improve their quality of life.   

Enrollment Status: Currently Enrolling  

  • Inclusion Criteria 
  • Cats with IRIS Stage II-IV CKD (Serum Creat >1.6 mg/dL) 
  • Hypokalemia, defined as a serum potassium < 4.0 mmol/L  
  • Stable diet for 2weeks 


  • Exclusion Criteria  
  • The presence or strong suspicion for hyperaldosteronism 
  • The presence of severe diarrhea or *vomiting (*particularly if caused by concurrent uncontrolled disease other than CKD such as chronic enteropathy, pancreatitis, hepatobiliary disease, hyperthyroidism, etc.) 
  • Evidence of metabolic acidosis secondary to causes other than CKD 
  • Concurrent use of ACEi, ARB, spironolactone, or other drugs which are known to have interactions with either potassium citrate and/or potassium gluconate  


  • Procedures/Treatment:  
  • At the time of enrollment your cat will receive a physical examination and comprehensive laboratory screening to confirm stage of CKD and hypokalemia and exclude other newly diagnosed conditions (ex. Hyperthyroidism, hypertension) 
  • After confirmation of enrollment, your cat will be randomized to receive potassium citrate or potassium gluconate which will be administered orally as either pill or powered every 12 hours for 28 days.  
  • You will be asked to bring your cat back for 2 recheck visits (day 14 and 28) for a physical exam, blood and urine collection.  A summary of events is presented in the table below.  
Procedure   Enrollment  

Day 0  

Day 7 

± 3  

Day 14  

± 3 

Day 28  

± 3  

Informed consent   X        
Medical history   X   X   X   X  
Dietary history   X   X   X   X  
Physical examination  X     X   X  
Phone check in    X     
Systolic blood pressure   X        
Hematology   X     X   X  
Biochemistry   X     X   X  
Urinalysis   X     X   X  
Total T4   X        
iSTAT CG8+  X    X  X 
Urine ammonia:creat ratio  X    X  X 
Banked plasma and urine   X      X   X  


  • Costs:  There is no cost to you for enrolling your cat in this study. You will receive a complimentary physical examination for your cat and diagnostic testing.   
  • Contact:  Please email VM-clinicalstudies@ufl.edu or call Clinical Studies at 352-294-4389 if you are interested in learning more. 
  • Study Investigators: Drs. Autumn N. Harris, Andrew J. Specht, and Kristen Cooke 


  • Background 

Hypokalemia is an important clinical consequence of CKD in cats, resulting in clinical signs such as weakness, polyuria, polydipsia, anorexia, and constipation. Likewise, metabolic acidosis is another significant consequence of CKD, resulting in both bone demineralization and muscle catabolism, as well as having a direct effect on the progression of CKD in both human and veterinary medicine.  

To date, potassium gluconate has been the potassium supplement formulation of choice in cats with CKD and associated hypokalemia. Potassium citrate is another supplement formulated for management of hypokalemia. A recent retrospective study comparing potassium citrate and potassium gluconate on serum potassium levels, found that both were equally effective in treating hypokalemia.  

The treatment of metabolic acidosis in cats with CKD still remains a challenge. Although sodium bicarbonate has been shown to be effective in increasing serum bicarbonate levels to help correct metabolic acidosis, it has several potential side effects which are concerning, including possible fluid retention, edema and worsening hypertension. Potassium citrate has known alkalinizing properties and has the advantage of minimal side effects as compared to sodium bicarbonate; however, there is very little information available regarding the efficacy of potassium citrate as a treatment modality for metabolic acidosis. 


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