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Diabetes Obes Metab. 2018 Jul;20(7):1776-1780. doi: 10.1111/dom.13274. Epub 2018 Mar 24.

Role of bicarbonate supplementation on urine uric acid crystals and diabetic tubulopathy in adults with type 1 diabetes.

Author information

1
Division of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
2
Department of Clinical Research, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado.
3
Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
4
Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
5
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.
6
Midwestern School of Medicine, Glendale, Arizona.
7
Regis University, Denver, Colorado.
8
Division of Nephrology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada.
9
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado.

Abstract

Uricosuria and crystallization are increasingly recognized risk factors for diabetic tubulopathy. This pilot clinical trial aimed to determine the acute effect of urinary alkalinization using oral sodium bicarbonate (NaHCO3 ) on UA crystals in adults with type 1 diabetes (T1D). Adults with T1D, ages 18 to 65 years (n = 45, 60% female, HbA1c, 7.5 ± 1.2%, 20.2 ± 9.3 years duration) without chronic kidney disease (eGFR ≥60 mL/min/1.73 m2 and albumin-to-creatinine ratio < 30 mg/g) received 2 doses of 1950 mg oral NaHCO3 over 24 hours. Fasting urine and serum were collected pre- and post-intervention. UA crystals were identified under polarized microscopy. Urine measurements included: osmolality, pH, UA, creatinine and kidney injury molecule-1 (KIM-1). NaHCO3 therapy increased mean ± SD urine pH from 6.1 ± 0.7 to 6.5 ± 0.7 (P < .0001). Prior to therapy, 31.0% of participants had UA crystals vs 6.7% post therapy (P = .005). Change in urine pH inversely correlated with change in urine KIM-1 (r:-0.51, P = .0003). In addition, change in urine UA over 24 hours correlated with change in urine KIM-1 (r:0.37, P = .01). In conclusion, oral NaHCO3 normalized urine pH and decreased UA crystals, and may hold promise as an inexpensive and safe tubulo-protective intervention in individuals with T1D.

KEYWORDS:

sodium bicarbonate; type 1 diabetes; uric acid; urine uric acid crystals

PMID:
29498467
PMCID:
PMC6344349
[Available on 2019-07-01]
DOI:
10.1111/dom.13274
[Indexed for MEDLINE]

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