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JU INSIGHT Alkaline Water: Help or Hype for Uric Acid and Cystine Urolithiasis?

By: Paul Piedras, BS, University of California, Irvine, Orange; Andrei D. Cumpanas, MD, University of California, Irvine, Orange; Amanda McCormac, BS, University of California, Irvine, Orange; Seyed Amiryaghoub M. Lavasani, BA, University of California, Irvine, Orange; Antonio R. H. Gorgen, MD, University of California, Irvine, Orange; Allen Rojhani, MD, University of California, Irvine, Orange; Minh-Chau Vu, BS, University of California, Irvine, Orange; Rohit Bhatt, MD, University of California, Irvine, Orange; John Asplin, MD, Litholink Corporation, Labcorp, Ithasca, Illinois; Zachary E. Tano, MD, University of California, Irvine, Orange; Jaime Landman, MD, University of California, Irvine, Orange; Ralph V. Clayman, MD, University of California, Irvine, Orange; Roshan M. Patel, MD, University of California, Irvine, Orange | Posted on: 21 Feb 2024

Piedras P, Cumpanas AD, McCormac A, et al. Alkaline water: help or hype for uric acid and cystine urolithiasis?. J Urol. 2024;211(2):276-284.

Study Need and Importance

Urinary alkalization is a cornerstone in the medical management of patients with low urine pH, usually associated with uric acid or cysteine stones. Given the poor adherence to the mainstay therapy (ie, potassium citrate) finding a more practical, cost-effective therapeutic measure that facilitates an increase in urine pH would be beneficial. We sought to evaluate the impact of alkaline water and 49 other beverages and supplements to evaluate their alkali/citrate content and hence their potential to increase urine pH. Five different brands of “high pH and low mineral” bottled alkaline water were tested at Litholink to determine the electrolyte and alkali content. Additionally, a comprehensive review was done to detail the alkali, sodium, and caloric content of other over-the-counter beverages and supplements. The cost for supplying the daily recommended amount of alkali per month was determined for all studied and reviewed substances, and a handout was created to facilitate distribution of this information in an office setting (Figure).

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Figure. A list of over-the-counter and medical food supplements/beverages and their respective alkali content, sodium content, calories, and cost per serving size. This table can be downloaded as a patient handout via the QR code.

What We Found

High-pH, low-mineral alkaline water was found to contain less than 1 mEq/L of alkali. Alternatively, we have identified 11 specific beverages or supplements with significantly higher alkali content, among which the most cost-effective would be baking soda. These options are capable of meeting the daily alkali intake recommendations set by the AUA and the European Association of Urology when consumed in 2 to 3 servings.

Limitations

This study is not without limitations as alkaline water was only tested in a laboratory via biochemical analysis and not in human subjects.

Interpretation for Patient Care

The handout (download via QR code above) that was created is intended not only for health care providers, but also for patients. Our aim is to educate the public regarding the optimal beverage and supplement choices that may help increase urine pH and enhance the overall adherence to a therapeutic regimen for patients with uric acid and cystine urolithiasis.

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