Rheumatology- Oxford Academic Journal, Published  a prospective cohort study that investigated whether adding urine alkalization to urate-lowering therapy (ULT) improves outcomes in men with gout and low urinary pH (<6.2).

A total of 385 participants initiating febuxostat therapy were divided into groups based on whether they also received a citrate mixture for urine alkalization.

At 12 weeks, the alkalization group showed a significantly lower urine albumin-to-creatinine ratio (UACR), fewer gout flares, lower pain scores, and improved lipid profiles (lower triglycerides, higher HDL-C), despite requiring lower febuxostat doses. Serum urate targets and eGFR were similar between groups.

Why is this important?

While xanthine oxidase inhibitors like febuxostat lower serum urate, they don’t address urine acidity, which contributes to urate crystal formation and renal microvascular damage.

This study provides evidence that targeting urinary pH may offer complementary benefits, including reduction in albuminuria, an early marker of kidney damage, and mitigation of gout flares and metabolic dysfunction.

By reducing the need for higher drug doses and improving lipid metabolism, urine alkalization with products like Ketocitra or potassium citrate offers a low-risk, cost-effective adjunct that could help personalize gout and kidney disease management, particularly in patients with features of metabolic syndrome.

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