The Impact of Alternative Alkalinizing Agents on 24-Hour Urine Parameters
| Autor: | Charles D. Scales, Russell Terry, Evan Carlos, Michael E. Lipkin, Glenn M. Preminger, Leah G. Davis, Brenton Winship, Sarah Yttri, Kohldon Boydston |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Hyperkalemia Urology Potassium 030232 urology & nephrology chemistry.chemical_element Urine Urinalysis Nephrolithiasis Citric Acid Potassium bicarbonate 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Potassium Citrate Humans Medicine Aged Retrospective Studies 24 h urine Sodium bicarbonate business.industry Reproducibility of Results Retrospective cohort study Hydrogen-Ion Concentration Middle Aged chemistry 030220 oncology & carcinogenesis Female Antacids medicine.symptom business Hypocitraturia |
| Zdroj: | Urology. 142:55-59 |
| ISSN: | 0090-4295 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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