Objective
To evaluate the effects of oral sodium bicarbonate (NaBic) supplementation upon urinary
citrate excretion in calcium stone formers (CSFs).
Methods
Sixteen adult calcium stone formers with hypocitraturia were enrolled in a randomized,
double-blind, crossover protocol using 60 mEq/day of NaBic during 3 days compared
to the same period and doses of potassium citrate (KCit) supplementation. Blood and
24-hour urine samples were collected at baseline and during the third day of each
alkali salt.
Results
NaBic, similarly to KCit supplementation, led to an equivalent and significant increase
in urinary citrate and pH. Compared to baseline, NaBic led to a significant increase
in sodium excretion without concomitant increases in urinary calcium excretion, whereas
KCit induced a significant increase in potassium excretion coupled with a significant
reduction in urinary calcium. Although NaBic and KCit both reduced calcium oxalate
supersaturation (CaOxSS) significantly vs baseline, KCit reduced calcium oxalate supersaturation
significantly further vs NaBic. Both KCit and NaBic significantly reduced urinary
phosphate and increased calcium phosphate supersaturation (CaPSS) compared to baseline.
Finally, a significantly higher sodium urate supersaturation (NaUrSS) was observed
after the use of the 2 drugs.
Conclusion
This short-term study suggests that NaBic represents an effective alternative for
the treatment of hypocitraturic calcium oxalate stone formers who cannot tolerate
or afford the cost of KCit. In view of the increased sodium urate supersaturation,
patients with pure uric acid stones and high urate excretion may be less suited for
treatment with NaBic.
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References
- Ambulatory evaluation of nephrolithiasis: an update of a 1980 protocol.Am J Med. 1995; 98: 50-59
- Renal stone disease: causes, evaluation and medical treatment.Arq Bras Endocrinol Metabol. 2006; 50: 823-831
- Hypocitraturia: pathophysiology and medical management.Rev Urol. 2009; 11: 134-144
- Potassium and sodium intake and excretion in calcium stone forming patients.J Ren Nutr. 1998; 8: 127-131
- DASH-style diet and 24-hour urine composition.Clin J Am Soc Nephrol. 2010; 5: 2315-2322
- Noncitrus alkaline fruit: a dietary alternative for the treatment of hypocitraturic stone formers.J Endourol. 2012; 26: 1221-1226
- Comparative study of the influence of 3 types of mineral water in patients with idiopathic calcium lithiasis.J Urol. 1998; 159: 658-663
- Clinical study on the effect of mineral waters containing bicarbonate on the risk of urinary stone formation in patients with multiple episodes of CaOx-urolithiasis.World J Urol. 2007; 25: 315-323
- Impact of long-term potassium citrate therapy on urinary profiles and recurrent stone formation.J Urol. 2009; 181: 1145-1150
- Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis.J Urol. 1997; 158: 2069-2073
- Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone-forming salts.Kidney Int. 1983; 24: 348-352
- Preventive treatment of nephrolithiasis with alkali citrate--a critical review.Urol Res. 2005; 33: 73-79
- Risk formulas in calcium oxalate urolithiasis.World J Urol. 1997; 15: 176-185
- A simplified estimate of ion-activity product of calcium phosphate in urine.Eur Urol. 1984; 10: 191-195
- Kidney stones: medical and surgical management.Lippincott-Raven Publishers, Philadelphia1996 (33-64)
- Organic anions and potassium salts in nutrition and metabolism.Nutr Res Rev. 2004; 17: 249-258
- Contrasting effects of various potassium salts on renal citrate excretion.J Clin Endocrinol Metab. 1991; 72: 396-400
- A comparison of the effects of potassium citrate and sodium bicarbonate in the alkalinization of urine in homozygous cystinuria.Urol Res. 2001; 29: 295-302
- Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men.Kidney Int. 1989; 35: 688-695
- Potassium administration reduces and potassium deprivation increases urinary calcium excretion in healthy adults [corrected].Kidney Int. 1991; 39: 973-983
- Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women.J Clin Endocrinol Metab. 2009; 94: 96-102
- Pharmacotherapy of urolithiasis: evidence from clinical trials.Kidney Int. 2011; 79: 385-392
- Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial.J Endourol. 2002; 16: 149-152
- Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis--a prospective randomized study.Br J Urol. 1994; 73: 362-365
- Randomized double-blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis.J Urol. 1993; 150: 1761-1764
Article Info
Publication History
Published online: April 19, 2013
Accepted:
March 1,
2013
Received:
December 13,
2012
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This research was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP - Grant: 2010/04719-1 ) and Fundação Oswaldo Ramos - Hospital do Rim e Hipertensão from Universidade Federal de São Paulo.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
