PD21-12 CLINICAL COMPARISON OF NON-PRESCRIPTION OVER-THE-COUNTER URINARY ALKALINIZING AGENTS: EFFECTS ON URINARY CITRATE EXCRETION AND URINE pH

Abstract

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (PD21)1 Sep 2021PD21-12 CLINICAL COMPARISON OF NON-PRESCRIPTION OVER-THE-COUNTER URINARY ALKALINIZING AGENTS: EFFECTS ON URINARY CITRATE EXCRETION AND URINE pH Kristina L. Penniston, Riley J. Medenwald, Mariana M. Coughlin, Stephen Y. Nakada, and R. Allan Jhagroo Kristina L. PennistonKristina L. Penniston More articles by this author , Riley J. MedenwaldRiley J. Medenwald More articles by this author , Mariana M. CoughlinMariana M. Coughlin More articles by this author , Stephen Y. NakadaStephen Y. Nakada More articles by this author , and R. Allan JhagrooR. Allan Jhagroo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002010.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Low urine citrate (Cit) and pH increase risk for calcium and uric acid kidney stones, respectively. Prescriptive urinary alkalinizing agents are expensive, and many patients request alternatives. We tested effects of 2 over-the-counter products, baking soda (BS) and Litholyte® (LL) on 24 h urine (24U) Cit and pH in patients with low 24U Cit, pH, or both. We hypothesized they had equivalent effect. METHODS: Patients with a history of urolithiasis participated in this IRB-approved study if 24U Cit was <420 mg and/or pH was <5.9 when evaluated in our clinic. Patients were randomized to 40 mEq of LL taken AM and PM (20 mEq each time) or 40 mEq alkali from BS as follows: 1/4 level tsp in water in AM and 1/2 tsp in PM. During the last 1-2 weeks of the 90-day treatment, patients completed a 24U collection, a side effects survey, and the Wisconsin Stone Quality of Life (QOL) questionnaire. We compared baseline and follow-up measures within and between groups. Patients were excluded from analysis if 24U creatinine between their 24U collections differed by >35%. Outcomes were changes in 24U Cit, pH, and NH4. We measured change in 24U calcium to assess calciuric potential of BS. RESULTS: Patients completing both 24U collections (11 of 13 on BS; 8 of 15 on LL) did not differ at baseline for 24U Cit, pH, NH4, or calcium; for stone-related QOL; nor for prevalence of low 24U Cit (54 vs 50%), pH (69 vs 88%), or both (46 vs 38%). Both treatments increased 24U Cit (median-max, 154 and 589 mg for BS; 96 and 389 mg for LL) and pH (figure), and changes were not different between groups. However, within-group changes in 24U Cit, pH, and NH4 were significant only with BS (p≤0.006, asterisks in figure). Follow-up prevalence of low urine Cit, pH, or both was slightly lower on BS vs LL (27 vs 36% for 24U Cit; and 37 vs 47% for pH). 24U calcium did not change in either group. Stone-related QOL improved by 10% in both groups; the largest improvement was in disease symptoms. Patients on BS tended to more frequently forget a dose than those on LL (50 vs 33%) and were more likely to be concerned about side effects (33 vs. 17%). CONCLUSIONS: BS and LL both increased 24U Cit and pH without increasing calcium. All changes were clinically relevant; within-group changes were significant only in those using BS. Source of Funding: LithoLyte product donated by Dr. Ryan Holland © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e379-e379 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristina L. Penniston More articles by this author Riley J. Medenwald More articles by this author Mariana M. Coughlin More articles by this author Stephen Y. Nakada More articles by this author R. Allan Jhagroo More articles by this author Expand All Advertisement Loading ...