Background Gout is a complex metabolic and inflammatory disease with varying clinical presentations including gouty arthritis, uric acid nephrolithiasis and renal impairment. Urine alkalinization may be a useful adjunct in the management of gout.
As part of the 3e initiative for generating recommendations for the diagnosis and management of gout, we performed a systematic review using Cochrane methods to determine the efficacy and safety of urine alkalinization in patients with uric acid nephrolithiasis with or without gouty arthritis.
Objectives Determine the efficacy and safety of urine alkalinization in patients with uric acid nephrolithiasis with or without gouty arthritis.
Methods We searched Medline, EMBASE and Cochrane databases to March 2012, and 2010-11 ACR/EULAR abstracts to identify all randomized controlled trials (RCTs) and quasi-RCTs that compared urine alkalinization to placebo or another therapy in people with uric acid nephrolithiasis with or without gouty arthritis. Primary outcomes were uric acid stone regression and withdrawals due to adverse effects. Two review authors independently selected studies for inclusion, assessed risk of bias (RoB) and extracted data using Cochrane methods.
Results A total of 7103 articles were identified, of which 76 articles were selected for detailed review and two fulfilled inclusion criteria. One trial (60 participants) was judged to be at low risk of bias (RoB) and compared potassium citrate to phytotherapy. At 12 weeks, 14/30 (47%) people who received potassium citrate achieved uric acid stone remission compared to 9/30 (30%) in the phytotherapy group (P=0.05). The other trial (191 participants) was judged to be at unclear RoB and compared four treatment arms: potassium citrate and tamsulosin versus placebo or potassium citrate or tamsulosin. At 4 weeks, 27/46 (59%) who received potassium citrate achieved stone remission compared to 12/46 (26%) in the placebo group (P=0.003). There were no withdrawals in either trial due to adverse events.
Conclusions There is limited evidence from two trials (1 at low RoB and 1 at unclear RoB) that urine alkalinization may be an efficacious and safe treatment for patients with uric acid nephrolithiasis with or without gouty arthritis.
Disclosure of Interest None Declared