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

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Synopsis

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

Bicarbonate (commonly in the form of sodium bicarbonate or potassium bicarbonate) is scientifically validated for use in the management of certain types of kidney stones, particularly uric acid and cystine stones. The therapeutic rationale is based on bicarbonate’s ability to alkalinize urine. Many kidney stones form in acidic urine; by raising the pH, bicarbonate can prevent the formation and promote the dissolution of uric acid and cystine stones, which are more soluble at higher pH levels (Nephrolithiasis: Treatment, diet, and prevention, UpToDate 2024; Kidney International Supplements, 2016).

Clinical guidelines recommend urinary alkalinization with oral alkali therapy (such as sodium or potassium bicarbonate, or potassium citrate) for patients with recurrent uric acid or cystine stones. Several controlled trials and observational studies have shown that regular bicarbonate supplementation can significantly reduce stone recurrence and, in some cases, dissolve existing stones by maintaining urine pH above 6.0-6.5 (American Urological Association Guidelines, 2019). However, it is not effective for preventing or treating calcium oxalate stones, the most common type, unless there is an associated metabolic acidosis.

Potential drawbacks include the risk of metabolic alkalosis, sodium overload (with sodium bicarbonate), and contraindications in patients with heart failure or hypertension. Nevertheless, for the appropriate stone type, bicarbonate therapy is a well-established, evidence-based intervention.

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