Chan Carter, Sui Wilson, Breeggemann Matthew C, Stoller Marshall
College of Medicine, California Northstate University, Elk Grove, CA, USA.
Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Transl Androl Urol. 2025 Aug 30;14(8):2428-2438. doi: 10.21037/tau-2025-275. Epub 2025 Aug 26.
Urinary pH is an important factor in the preventative management of kidney stones. A variety of options are available for modulating urinary pH, including pharmaceuticals, over the counter (OTC) formulations [such as stone specific OTCs, complementary and alternative medicines (CAMs), and home remedies], and dietary modifications. These options can be overwhelming for both providers and patients and vary with regards to cost, convenience, and efficacy. In the absence of a consolidated central source of information for patients and physicians to reference, our study aims to summarize and analyze the effectiveness of these various treatment approaches to provide a more comprehensive understanding of how common interventions alter urinary pH.
The PubMed database was used to identify human clinical trials related to pharmacologic and dietary interventions to modify urinary pH. Eligible studies were selected based on the following criteria: (I) observational or interventional study; (II) urinary pH as a reported outcome of the study intervention; (III) inclusion baseline or control urinary pH data; (IV) sufficient presentation of data for analytical purposes. Data was abstracted, and the mean changes in urinary pH for each intervention were compiled and grouped.
A total of 86 studies met inclusion criteria: 61 were randomized clinical trials, 20 were crossover or prospective studies, and 5 were observational cohort reports. In total, 150 individual experiments with a combined sample size of 2,895 were included. For urinary alkalinization, the most effective pharmaceutical, OTC formulation, and dietary change were sodium bicarbonate, Citro-Soda, and lacto-ovo-vegetarian diet, respectively. For urinary acidification, the most effective interventions were ammonium chloride, methionine, and high protein diet, respectively.
Our study found that pharmaceuticals are not the only effective options for altering urine pH; select dietary changes and OTC options are also viable for patients. When considering cost, accessibility and side effects, these alternative options may be more appealing to some patients, potentially improving adherence compared to pharmaceuticals.
尿液pH值是肾结石预防管理中的一个重要因素。调节尿液pH值有多种选择，包括药物、非处方（OTC）制剂[如特定结石的非处方药、补充和替代医学（CAM）以及家庭疗法]，以及饮食调整。这些选择对于医疗服务提供者和患者来说可能令人应接不暇，并且在成本、便利性和疗效方面各不相同。由于缺乏供患者和医生参考的综合信息中心来源，我们的研究旨在总结和分析这些不同治疗方法的有效性，以便更全面地了解常见干预措施如何改变尿液pH值。
使用PubMed数据库识别与改变尿液pH值的药物和饮食干预相关的人体临床试验。根据以下标准选择符合条件的研究：（I）观察性或干预性研究；（II）尿液pH值作为研究干预的报告结果；（III）纳入基线或对照尿液pH值数据；（IV）有足够的数据呈现以用于分析目的。提取数据，并汇总和分组每种干预措施的尿液pH值平均变化。
共有86项研究符合纳入标准：61项为随机临床试验，20项为交叉或前瞻性研究，5项为观察性队列报告。总共纳入了150项个体实验，合并样本量为2895。对于尿液碱化，最有效的药物、非处方制剂和饮食变化分别是碳酸氢钠、柠檬酸汽水和蛋奶素食饮食。对于尿液酸化，最有效的干预措施分别是氯化铵、蛋氨酸和高蛋白饮食。
我们的研究发现，药物并非改变尿液pH值的唯一有效选择；某些饮食变化和非处方选择对患者也可行。在考虑成本、可及性和副作用时，这些替代选择可能对一些患者更具吸引力，与药物相比可能提高依从性。
