Abstract
Objectives
To determine if alternative alkalinizing agents lead to similar changes in 24-hour
urine pH and citrate compared to potassium citrate (KCIT). Many stone formers cannot
tolerate KCIT due to side effects or cost. In these patients, we have prescribed potassium
bicarbonate or sodium bicarbonate as alternative alkali (AA), though their efficacy
is unclear.
Methods
We performed a retrospective cohort study of adult stone formers seen from 2000 to
2018 with 24-hour urine analyses. Two analyses were performed. The first evaluated
the alkalinizing and citraturic effects in patients with baseline low urine pH or
hypocitraturia off of any alkalinizing medications, who were subsequently treated
with either KCIT or AA. The second analysis compared the pH and citrate in patients
changing from KCIT to an AA. Reasons for switching were abstracted by chart review
and cost savings percentages were calculated using GoodRx medication prices.
Results
When starting alkali therapy, the median increase in pH from baseline was 0.64 for
KCIT and 0.51 for AA (P = .077), and the median increase in citrate from baseline was 231 mg for KCIT and
171 mg for AA (P = .109). When switching alkali therapy, median pH and citrate did not significantly
change. Hyperkalemia (24%), GI upset (19%), and cost (17%) were the most common reasons
cited for switching to an AA. AA represented a savings of 86%-92% compared to KCIT.
Conclusion
Alternative alkali appear to offer comparable improvements in 24-hour urine parameters
and significant cost-savings compared to KCIT.
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Article info
Publication history
Published online: April 21, 2020
Accepted:
April 7,
2020
Received:
January 2,
2020
Footnotes
Conflict of Interest: Authors declare that they have no conflict of interest.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
