MP12-20 THE IMPACT OF ALTERNATIVE ALKALINIZING AGENTS ON 24-HOUR URINE COLLECTION PARAMETERS (2019)

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP12)1 Apr 2019MP12-20 THE IMPACT OF ALTERNATIVE ALKALINIZING AGENTS ON 24-HOUR URINE COLLECTION PARAMETERS Kohldon Boydston*, Brenton Winship, Russell Terry, Leah Davis, Michael Lipkin, Glenn Preminger, and Sarah Yttri Kohldon Boydston*Kohldon Boydston* More articles by this author , Brenton WinshipBrenton Winship More articles by this author , Russell TerryRussell Terry More articles by this author , Leah DavisLeah Davis More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , and Sarah YttriSarah Yttri More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555213.74850.47AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Patients with low urine pH or hypocitraturia and nephrolithiasis benefit from medical treatment with potassium citrate (KCIT). Many patients cannot take KCIT due to side effects or cost. In these patients, we have prescribed potassium bicarbonate or sodium bicarbonate as alternative alkalinizing agents (AA), though their efficacy in treating these metabolic abnormalities is unclear. We sought to determine if AA prescribed to recurrent stone formers led to similar changes in 24-hour urine pH and citrate compared to KCIT. METHODS: We performed a retrospective cohort study of adult stone formers seen from 2000-2018 with available 24-hour urine analyses. Demographics, medical history, and medications were abstracted. Two analyses were performed. The first included patients with baseline low urine pH (< 6.0) or hypocitraturia (<450 mg men, <550 mg women) off of any alkalinizing medications, who were subsequently treated with either KCIT or AA. Primary outcomes were median change in urinary pH and citrate on 24-hour urine collection after therapy. The second analysis compared the pH and citrate in patients changing from KCIT to an AA before and after the transition in a paired analysis. Comparisons were made using Wilcoxon rank sum and Wilcoxon signed rank tests. Cost savings percentages were calculated using per-pill GoodRx medication prices as of October 2018. RESULTS: In the first analysis, 482 KCIT and 70 AA patients were identified. Patients on AA had statistically significant differences in baseline demographics, including a lower diabetes prevalence, older age, and lower starting pH and citrate. The median increase in pH from baseline was 0.64 for KCIT and 0.51 for AA (p=0.077), and the median increase in citrate from baseline was 231 mg for KCIT and 171 mg for AA (p=0.109). In the second analysis, 71 patients were identified. The median changes in pH and citrate when switching from KCIT to an AA were -0.02 (p=0.641) and 15.91 (p=0.989), respectively. GI upset (32%), hyperkalemia (21%), cost (21%), and pill size/taste (9%) were the most common reasons cited for switching to an AA. AA represented a per-pill cost savings of 83-96% compared to KCIT. CONCLUSIONS: Alternative alkalinizing agents lead to significant cost-savings and comparable improvements in 24-hour urine pH and citrate compared to KCIT, the standard of care. These findings confirm that there are several options available to recurrent stone formers requiring long-term metabolic therapy. Source of Funding: None Durham, NC© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e176-e176 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kohldon Boydston* More articles by this author Brenton Winship More articles by this author Russell Terry More articles by this author Leah Davis More articles by this author Michael Lipkin More articles by this author Glenn Preminger More articles by this author Sarah Yttri More articles by this author Expand All Advertisement PDF downloadLoading ...