Role of bicarbonate supplementation on urine uric acid crystals and diabetic tubulopathy in adults with type 1 diabetes.

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 m2 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.

• Authors: Petter Bjornstad, David M Maahs, Carlos A Roncal, Janet K Snell-Bergeon, Viral N Shah, Tamara Milagres, Samuel L Ellis, Matthew Hatch, Linh T Chung, Marian J Rewers, Satish Garg, David Z Cherney, Laura Pyle, Kristen J Nadeau, Richard J Johnson
• Journal: Diabetes, obesity & metabolism (Diabetes Obes Metab) Vol. 20 Issue 7 Pg. 1776-1780 (07 2018) ISSN: 1463-1326 [Electronic] England
• PMID: 29498467 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 John Wiley & Sons Ltd.

Chemical References

• HAVCR1 protein, human
• Hepatitis A Virus Cellular Receptor 1
• Uric Acid
• Sodium Bicarbonate
• Creatinine

Topics

• Adult
• Creatinine (urine)
• Diabetes Mellitus, Type 1 (urine)
• Diabetic Nephropathies (urine)
• Dietary Supplements
• Female
• Glomerular Filtration Rate
• Hepatitis A Virus Cellular Receptor 1 (metabolism)
• Humans
• Hydrogen-Ion Concentration
• Male
• Microscopy, Polarization
• Osmolar Concentration
• Pilot Projects
• Sodium Bicarbonate (therapeutic use)
• Uric Acid (urine)