Hypocitraturia is one of the most common and correctable risk factors for nephrolithiasis. It is primarily caused by alterations in acid-base status, with several identified etiologies driving its pathogenesis. Diagnosis is made by at least one 24-hour urine study. Treatment involves identifying and reversing potential causes, followed by dietary modifications and alkali supplementation. Numerous new supplements have emerged in this space, gaining availability and popularity with patients. This article reviews pathophysiology, etiology, diagnosis, and treatment of hypocitraturia in the context of urolithiasis.