Evidence indicates that patients with ADPKD frequently have low levels of urinary citrate. With the suggestion by experts in the field that urinary citrate may be a marker of covert metabolic acidosis in chronic kidney disease, investigators analyzed the relationship between urinary citrate levels, renal function, and serum bicarbonate in patients with ADPKD.

Among participants, 75% had urinary citrate levels below 300 mg/gCr, as did 49% of those with stage 1 CKD, 79% of those with stage 2, 96% of those with stage 3, and 95% of those with stage 4. Whereas urinary citrate was correlated with serum creatinine and eGFR in both males and females, it was not correlated with serum bicarbonate. Lower urinary citrate levels were accompanied by a decline in urinary osmolality and renal excretion of uric acid and calcium.