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Role of bicarbonate supplementation on urine uric acid crystals and diabetic tubulopathy in adults with type 1 diabetes
Author(s) -
Bjornstad Petter,
Maahs David M.,
Roncal Carlos A.,
SnellBergeon 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.
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13274
Subject(s) - urine , medicine , urine osmolality , creatinine , endocrinology , sodium bicarbonate , tubulopathy , uric acid , kidney disease , type 1 diabetes , microalbuminuria , urology , diabetes mellitus , chemistry
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 (NaHCO 3 ) 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 NaHCO 3 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). NaHCO 3 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 NaHCO 3 normalized urine pH and decreased UA crystals, and may hold promise as an inexpensive and safe tubulo‐protective intervention in individuals with T1D.