A NEW prospective cohort study suggests that adding urine alkalization therapy to xanthine oxidase inhibitors like febuxostat could improve kidney health, reduce gout flares, and enhance metabolic outcomes in men with low urinary pH. The study provides strong evidence supporting the role of urine alkalization in optimising gout treatment.
The research included 385 men with gout and urine pH below 6.2, all of whom started urate-lowering therapy (ULT) with febuxostat. Participants either received febuxostat alone or in combination with alkalization therapy, which involved a 3.5g citrate mixture taken twice daily. Over a 12-week follow-up, results showed that those receiving alkalization therapy required a 20% lower dose of febuxostat to maintain target urate levels but experienced no difference in serum urate levels compared to those who did not receive alkalization.
Those who received alkalization therapy demonstrated significant improvements in multiple clinical parameters. Kidney function appeared to benefit, with a significant reduction in the urine albumin-to-creatinine ratio (UACR) compared to the control group. The intervention group also reported fewer gout flares and lower pain scores, suggesting a direct benefit in symptom management. Additionally, urine pH increased significantly from week 4 onwards, confirming the physiological effect of the therapy.
Beyond kidney health and symptom relief, urine alkalization therapy had an impact on metabolic markers. The study found that participants in the alkalization group had lower triglyceride levels and higher HDL cholesterol levels, indicating a potential role in improving cardiovascular risk factors often associated with gout. However, no significant differences were observed in estimated glomerular filtration rate (eGFR) or other metabolic outcomes between groups.
These findings suggest that urine alkalization therapy may play an important role in gout management, particularly for those with low urinary pH and metabolic complications. The approach could help reduce medication dosage, enhance kidney function, and lower cardiovascular risk. Further research is needed to evaluate long-term benefits and broader applicability in gout treatment.
Aleksandra Zurowska, EMJ
Reference
Wang C et al. Impact of adding urine alkalization therapy to xanthine oxidase inhibitor in gout management: a prospective cohort study. Rheumatology. 2025; DOI: 10.1093/rheumatology/keaf091.
