Impact of adding urine alkalization therapy to xanthine oxidase inhibitor in gout management: a prospective cohort study
Authors' conclusion
Urine alkalization was associated with lower UACR, fewer gout flares, and improved serum lipid profile in febuxostat-treated men with gout and low urine pH.
Study context
- Population
- Men with gout and low urinary pH (pH < 6.2) starting urate-lowering therapy (ULT) with febuxostat (20 mg daily, escalated to 40 mg daily if serum urate ≥360 µmol/l)343 completed week 12
- Participants
- 385 men
- Exposure
- Urine alkalization (3.5 g bid citrate mixture) added to febuxostat ULT vs febuxostat ULT without alkalization
- Alkalizationn = 137
- Controlsn = 206reference
- Outcome
- Urine albumin-to-creatinine ratio (UACR)
- Follow-up
- Week 12
Methodological detailsalkalization based on patient preference
- Alkalization based on patient preference
Main finding
As reported in the abstract
UACR
- Alkalization vs Controls: P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Urine pH · from week 4Urine pH increased significantly in the alkalization group | P < 0.001 |
| Gout flares and pain VAS | P < 0.001 |
| Serum triglyceridesLower with alkalization | P < 0.01 |
| HDL-CHigher with alkalization | P < 0.001 |
- Gout flares and pain VAS: fewer gout flares and lower pain VAS scores with alkalization
Febuxostat dose · week 12
- Significantly lower febuxostat dose with alkalization (by ∼20%)
Serum urate at target <360 µmol/l · week 12
- No significant difference
eGFR · week 12
- Not significantly different
Other metabolic outcomes
- No other differences observed
Original publication
Impact of adding urine alkalization therapy to xanthine oxidase inhibitor in gout management: a prospective cohort study. Rheumatology (Oxford). Published 11 February 2025. doi:10.
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