Presented by: Paul Piedras BS
UCI

Introduction

Alkaline water with a pH range of 8-10 has been considered as a possible therapeutic approach to urinary alkalinization among patients suffering from uric acid urolithiasis. The general starting recommendation for urinary alkalization is the daily ingestion of 30 mEq of alkali. For any fluid to have an alkalinizing effect on urine, it must contain organic anions such as bicarbonate or citrate. Common therapies targeted for uric acid stone patients, either prescribed or purchased over the counter, may present a significant financial burden (i.e., $200/month). Accordingly, we conducted an analysis of the electrolyte and organic anion composition of five commercially available alkaline water products. Furthermore, we implemented a systematic review of previously reported beverages and supplements that might facilitate urinary alkalinization.

Materials

Five commercially available alkaline water brands (Essentia®, Smart Water® Alkaline, Great Value™ Hydrate Alkaline Water, Body Armor® SportWater, and Perfect Hydration®) underwent anion chromatography and direct chemical measurements to determine their mineral contents. A comprehensive review of 49 additional over-the-counter beverages and supplements was done to detail their alkali, sodium, and caloric content per serving.

Results

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The pH levels of the five alkaline waters ranged from 9.69-10.15; however, the physiologic alkali content was uniformly < 1 mEq (Table 1). There were only 12 out of 49 supplements or beverages which with 3 servings/day or fewer, provided an alkali content equal to the AUA and EAU 30 mEq daily intake recommendations for alkalinizing the urine among uric acid stone formers (in green on Table 2).

Conclusion

Despite its high pH, alkaline water fails to provide the necessary alkali to raise the urine pH. Among 49 other sources of urinary alkali, only sodium bicarbonate (i.e., baking soda) and Now® potassium citrate have the dual benefit of low cost and sufficient alkali content.  

Funding

N/A

Lead Authors

Andrei Cumpanas, MD
UCI

Co-Authors

Amanda McCormac, BS
UCI

Seyed Amiryaghoub Lavasani, BA
UCI

Antonio Gorgen, MD
UCI

Allen Rojhani, MD
UCI

Rohit Bhatt, MD
UCI

Minh-Chau Vu, BS
UCI

John Asplin, MD, FACS
Litholink Corporation, Labcorp®

Zachary Tano, MD
UCI

Jaime Landman, MD
UCI

Ralph Clayman, MD
UCI

Roshan Patel, MD
UCI