Evidence supporting the use of: Bicarbonate (mixed)
For the health condition: Kidney Stones

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Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Bicarbonate, particularly in the form of sodium bicarbonate or potassium bicarbonate, is scientifically validated as a supportive treatment for certain types of kidney stones, specifically uric acid and cystine stones. The rationale is based on the ability of bicarbonate to alkalinize the urine. Uric acid and cystine stones form more readily in acidic urine; by increasing the urinary pH, bicarbonate reduces the solubility of these stone-forming substances, thereby decreasing the risk of stone formation and aiding in the dissolution of existing stones.

Multiple clinical guidelines and studies support the use of oral alkalinizing agents, including bicarbonate, for the prevention and treatment of uric acid stones (see American Urological Association Guidelines, 2016; Sakhaee, K. et al., 2009, Kidney International). Bicarbonate therapy is less relevant for calcium oxalate or calcium phosphate stones, where alkalinization may not be beneficial or could even be detrimental.

The standard clinical protocol involves regular monitoring of urinary pH and careful dose adjustment of bicarbonate to maintain the optimal pH range (typically 6.0–7.0 for uric acid stones). Side effects, such as sodium load and potential metabolic alkalosis, must be monitored, especially in patients with cardiovascular or renal comorbidities. In summary, the use of bicarbonate for certain kidney stones is well-established and supported by moderate to strong clinical evidence.

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