Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Alkali therapy, most commonly in the form of potassium citrate or sodium bicarbonate, is scientifically validated as a treatment to support uric acid retention issues, such as those seen in gout or uric acid nephrolithiasis (kidney stones). Uric acid has low solubility in acidic urine and tends to precipitate, forming crystals that can cause both renal stones and aggravation of gout. The core of alkali therapy is to alkalinize the urine, thereby increasing the solubility of uric acid and promoting its excretion. Numerous clinical guidelines (e.g., American Urological Association, European Association of Urology) recommend the use of alkalinizing agents to maintain urinary pH between 6.0 and 6.5 in patients at risk of uric acid stones. Randomized controlled trials and observational studies have shown that urine alkalinization with alkali therapy reduces stone formation and can facilitate the dissolution of existing uric acid stones. While alkali therapy does not reduce serum uric acid levels directly (for which xanthine oxidase inhibitors are used), it is effective in managing the urinary complications of uric acid retention. The evidence base is robust, with clear mechanistic understanding and decades of clinical application supporting its role in this context.

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