Alkalinizing Agents: A Review of Prescription, Over-the-Counter, and Medical Food Supplements

Stern, Karen; Canvasser, Noah; Borofsky, Michael S.; Gleason, Vanessa; Kamphuis, Guido; Tayeb, Marawan M. El; Hsi, Ryan S.; Scotland, Kymora B.

doi:10.1089/end.2019.0292

Cited by 21 publications

(15 citation statements)

References 27 publications

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“…Potassium citrate is the first choice to dissolve and prevent urinary acid kidney stones in the clinic [ 12 ]. Nevertheless, only 13% of patients who used potassium citrate to treat kidney stones can maintain long-term medication, because potassium citrate causes adverse effects such as abdominal pain and diarrhoea [ 13 ]. Citrate mixture has been reported to alkalize urine as well as to improve renal function [ 14 ], with its high water solubility and more acceptable taste.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of citrate mixture vs sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study

Xue

Liu

et al. 2020

Rheumatology

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Objectives To compare the efficacy and safety of citrate mixture and sodium bicarbonate on urine alkalization in gout patients under benzbromarone treatment. Methods A prospective, randomized, parallel controlled trial was conducted among 200 gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University. The participants were randomly divided into two groups (1:1), sodium bicarbonate group (3 g/day) and citrate mixture group (7 g/day). All patients were prescribed with 25 mg/day benzbromarone at initiation and maintained at a dose of 50 mg/day. Clinical and biochemical data were collected at each follow-up time point (baseline, weeks 2, 4, 8 and 12). Results A total of 182 patients completed the 12-week urine alkalization study. The urine pH value of both groups increased significantly from the baseline to the final follow-up time point (sodium bicarbonate group, 5.50–6.00, P < 0.05; citrate mixture group, 5.53–5.93, P < 0.05). While the comparisons regarding urine pH between treatment groups showed no significant differences for each time point. The estimated glomerular filtration rate (eGFR) dropped significantly after 12 weeks’ trial in the sodium bicarbonate group (P < 0.01), while it was comparable between baseline and the last follow-up (P > 0.05) in the citrate mixture group. Results of urine analysis showed that the incident rate of occult blood in the sodium bicarbonate group was higher than that in the citrate mixture group (38 vs 24%, P < 0.05), accompanied by a similar occurrence of kidney stones. After 12-week follow-up, the frequency of twice gout flare in the citrate mixture group was significantly lower than that in sodium bicarbonate group (4 vs 12%, P = 0.037). No treatment-emergent adverse events occurred. Conclusion The efficacy of citrate mixture on urine alkalization is comparable to sodium bicarbonate under benzbromarone treatment without significant adverse events. Citrate mixture is superior to sodium bicarbonate in lowering the incidence of urine occult blood and the frequency of gout attacks. Trial registration Registered with ChiCTR (http://www.chictr.org.cn), No. ChiCTR1800018518.

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Section: Introductionmentioning

confidence: 99%

The efficacy and safety of citrate mixture vs sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study

Xue

Liu

et al. 2020

Rheumatology

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“…Potassium citrate is frequently used as a urine alkalinizing agent to reduce lithogenic risk, compared with prescription-strength formulations, over-the-counter alkalinizing agents appear to be substantially less expensive, although they potentially contain fewer citrate alkali equivalents. 15 In our study, the presence or absence of evidence-based support for the ingredients or product was not associated with product price or consumer ratings, on which patients may rely to make purchasing decisions. Furthermore, many labels recommend taking the supplements two to three times daily (Table 1), each with multiple glasses of water; it is possible that any perceived benefit of the supplements could be achieved through guidelinerecommended water gluttony, 1 although the evidence review could not definitively confirm this.…”

Section: Discussionmentioning

confidence: 47%

“…While advances in ureteroscopic lithotripsy and percutaneous nephrolithotomy have reduced the morbidity of stone surgery, ureteral stent-related symptoms, including flank pain and irritative lower urinary tract symptoms, may adversely impact patients' quality of life. 16 Patients may also encounter increased expense 15 and perceive negative health-related quality of life associated with the side effects of medications commonly prescribed in stone disease, 17 such as potassium citrate and thiazides, despite contrary evidence of experienced changes in qualityof-life parameters among patients taking these medications compared with nontakers. 18 For patients who are interested in dietary supplements and other complementary therapies, urologists should counsel that for the majority of ingredients, there are inadequate or absent data to give patients evidence-based recommendations.…”

Section: Discussionmentioning

confidence: 99%

Buyer Beware: Evidence-Based Evaluation of Dietary Supplements for Nephrolithiasis

Koo

Aro

Matlaga

2020

Journal of Endourology

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Introduction: Numerous dietary supplements claiming to treat or prevent kidney stones have recently been brought to the market. However, the evidence for these claims is not clear. This study assesses the scientific evidence supporting dietary supplements for the treatment and prevention of urinary stone disease. Materials and Methods: Two online marketplaces (Amazon and Google) were queried for dietary supplements available without a prescription to treat, alleviate, or prevent stone disease. Product labels were reviewed to compile stone-related claims and active ingredients. The 30-day cost of treatment and consumer star rating were assessed. MEDLINE, Web of Science, and Google Scholar were queried with labeled ingredients to assess the scientific evidence from published and lay sources. Results: A total of 27 dietary supplements containing 56 ingredients were analyzed. Supplements made a variety of claims, including dissolving stones (12 products, 44%), preventing stone formation (7 products, 26%), and reducing stone symptoms (6 products, 22%). Mean 30-day cost was $32 (range $4-$189). All products were rated highly by consumers (mean 4.2 of 5 stars). Of the 56 ingredients, 9 (16%) had any published studies for use in stone disease, and 5 (9%) had exclusively studies supporting their use. Eighteen scientific publications about the ingredients were identified, of which six showed mixed or no benefit in stone disease. Overall, 18 (67%) supplements contained ingredients with conflicting or absent evidence of benefit. No association was found between product cost or rating and products containing ingredients supported by human or animal studies (p > 0.05). Conclusions: Two-thirds of dietary supplements claiming to treat or prevent kidney stones contain ingredients with conflicting or no scientific evidence to support their claims. Clinicians should counsel stone formers that the effects of most supplements are unknown or unstudied in humans, and that the absence of evidence does not imply absence of potential harm.

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“…The concerns over our dependence on kcit as the primary source for alkali and citrate are prompting multiple parallel studies of dietary alternatives. 18,19 Aside from lemon-and orange-based beverages, other drinks, including grapefruit juice and coconut water, have shown similar changes in urinary citrate and pH after controlled consumption in healthy volunteers. 11,12 Compared with controls, after 4-7 days of grapefruit juice or coconut water consumption, urinary pH and citrate did increase, but these changes were all nonsignificant except for the increase in urinary citrate concentration after coconut water consumption (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…Concerns over the sugar, ascorbic acid, and artificial sweetener load with the consumption of low-calorie OJ on overall gut microbiome health, stone metabolite absorption, and any underlying metabolic syndrome will persist with the use of OJ; however, a better alternative to increase urinary pH is still lacking. For example, Lytholyte Ò asserts 45 mEq of alkali therapy for $2.25 per day 18 with no guaranteed fluid volume consumption compared with KCLO, which confers an average increase of 400 mL of urine at $1.46 per day for the same amount of alkali. To providers, we would recommend trying different brands of low-calorie OJ if patients report poor palatability.…”

Section: Discussionmentioning

confidence: 99%

Using Low-Calorie Orange Juice as a Dietary Alternative to Alkali Therapy

Large

Williams

Asplin

et al. 2020

Journal of Endourology

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Purpose: The pursuit of a dietary source to increase urine pH and citrate in stone formers has been ongoing for >30 years. Early evidence showed that orange juice (OJ) contains alkali and citrate, but high sugar and ascorbic acid content limited the use of OJ as a viable daily source of alkali. Recently, novel low-calorie OJs have emerged and could potentially be a better option. Methods: Beverages with high concentrations of alkali citrate and malate were identified using ion chromatography. Two low-calorie OJ beverages, in addition to crystal light lemonade beverage (CLLB), were chosen. Healthy volunteers (5 men, 5 women) drank 1 L of OJ or CLLB with 1 L water daily for 7 days, and then completed a 24-hour urinalysis. A washout week was instituted between trial weeks. The study design is a prospective randomized crossover control trial. A paired analysis using comparison of means was used to evaluate low-calorie OJ and CLLB. Volunteers had no prior history of kidney stones and maintained a journal with beverage compliance, side effect (SE), and dietary consumption data. Results: Tropicana 50 (TRP50), Kroger low-calorie OJ (KLCO), and CLLB were found to have a total alkali content of 56.60, 47.9, and 17.3 mEq/L, respectively, based on ion chromatography. Consumption of all three beverages raised urinary citrate (116.6 [-118 to 373, 177.9 [-3 to 359], 155.6 [-4 to 237] 6mg/day 95% confidence interval) and urinary pH (0.

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Alkalinizing Agents: A Review of Prescription, Over-the-Counter, and Medical Food Supplements

Cited by 21 publications

References 27 publications

The efficacy and safety of citrate mixture vs sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study

The efficacy and safety of citrate mixture vs sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study

Buyer Beware: Evidence-Based Evaluation of Dietary Supplements for Nephrolithiasis

Using Low-Calorie Orange Juice as a Dietary Alternative to Alkali Therapy

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