Role of bicarbonate supplementation on urine uric acid crystals and diabetic tubulopathy in adults with type 1 diabetes. Issue 7 (24th March 2018)

• Record Type: Journal Article
• Authors: Bjornstad, Petter; Maahs, David M.; Roncal, Carlos A.; Snell‐Bergeon, Janet K.; Shah, Viral N.; Milagres, Tamara; Ellis, Samuel L.; Hatch, Matthew; Chung, Linh T.; Rewers, Marian J.; Garg, Satish; Cherney, David Z.; Pyle, Laura; Nadeau, Kristen J.; Johnson, Richard J.
• Is Part Of: Diabetes, obesity & metabolism. Volume 20:Issue 7(2018)
• Page Start: 1776
• Page End: 1780
• Publication Date: 2018-03-24
• Subjects: sodium bicarbonate -- type 1 diabetes -- uric acid -- urine uric acid crystals; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.13274
• Languages: English
• ISSNs: 1462-8902

Abstract

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 m 2 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.