Comparing Alkalinizing Agents Efficacy on Stone Risk in Patients on a Metabolically Controlled Diet

NCT ID: NCT04651088

Last Updated: 2025-10-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

EARLY_PHASE1

Total Enrollment

15 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-31

Study Completion Date

2027-07-31

Brief Summary

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The purpose of this study is to compare over the counter and alternative prescription urinary alkalinizing agents to slow release potassium citrate in their ability to modify urinary parameters associated with stone formation.

Detailed Description

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Kidney stones are a common medical problem, occurring in almost 10% of people in the United States1. Furthermore, 50% of patients will recur within 10 years2. Metabolic testing is advised in recurrent stone formers, as well as those considered high risk, to assess for a specific abnormality which may prompt intervention to prevent future stone formation. Non-surgical interventions include both dietary counselling, as well as pharmacotherapy.

One of the most commonly prescribed class of pharmacotherapies is alkali therapy which can be used to both increase the urinary pH and raise the urine citrate levels. This is particularly useful as correction of very acidic urinary pH (\<5.5) can counteract uric acid crystallization thereby preventing or even dissolving uric acid stones3. Further, citrate has been shown to be a potent inhibitor of calcium stones by binding to the calcium directly4 and inhibiting crystal nucleation, thereby reducing calcium stone formation5,6.

The most commonly utilized preparation of alkali therapy is potassium citrate which has been shown to prevent stone formation better than sodium citrate7. Unfortunately, some forms of potassium citrate (crystal packets) have become unavailable, and the slow release form of potassium citrate (UroCit-K) now exceeds $15/day in cost8. There have been multiple alternative alkali therapies that have been used in place of potassium citrate, including both medical foods and prescription medications, but with little evidence to support their use. A pilot study in order to quantify the metabolic effects of these agents and compare them to potassium citrate will be performed.

Conditions

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Kidney Stone

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Metabolic diet

Controlled metabolic diet arm.

Group Type PLACEBO_COMPARATOR

Potassium citrate

Intervention Type DRUG

Slow release potassium citrate UroCit-K. Participants will take 20mEq twice daily.

Sodium bicarbonate

Intervention Type DRUG

650mg tabs. Take 3 tabs twice daily.

Litholyte

Intervention Type DIETARY_SUPPLEMENT

One packet is taken with 170ml of water. Two packets daily.

Crystal Lite

Intervention Type DIETARY_SUPPLEMENT

The classic lemonade contains 21.7mEq/liter of alkali Therefore, patients will take 2 litres daily to have the 40mEq of alkali daily needed.

Potassium Bicarbonate

Intervention Type DRUG

20 mEq tablets, one tablet twice daily

Potassium citrate

Group Type ACTIVE_COMPARATOR

Potassium citrate

Intervention Type DRUG

Slow release potassium citrate UroCit-K. Participants will take 20mEq twice daily.

Sodium bicarbonate

Intervention Type DRUG

650mg tabs. Take 3 tabs twice daily.

Litholyte

Intervention Type DIETARY_SUPPLEMENT

One packet is taken with 170ml of water. Two packets daily.

Crystal Lite

Intervention Type DIETARY_SUPPLEMENT

The classic lemonade contains 21.7mEq/liter of alkali Therefore, patients will take 2 litres daily to have the 40mEq of alkali daily needed.

Potassium Bicarbonate

Intervention Type DRUG

20 mEq tablets, one tablet twice daily

Sodium Bicarbonate

Group Type ACTIVE_COMPARATOR

Potassium citrate

Intervention Type DRUG

Slow release potassium citrate UroCit-K. Participants will take 20mEq twice daily.

Sodium bicarbonate

Intervention Type DRUG

650mg tabs. Take 3 tabs twice daily.

Litholyte

Intervention Type DIETARY_SUPPLEMENT

One packet is taken with 170ml of water. Two packets daily.

Crystal Lite

Intervention Type DIETARY_SUPPLEMENT

The classic lemonade contains 21.7mEq/liter of alkali Therefore, patients will take 2 litres daily to have the 40mEq of alkali daily needed.

Potassium Bicarbonate

Intervention Type DRUG

20 mEq tablets, one tablet twice daily

Litholyte arm

Group Type ACTIVE_COMPARATOR

Potassium citrate

Intervention Type DRUG

Slow release potassium citrate UroCit-K. Participants will take 20mEq twice daily.

Sodium bicarbonate

Intervention Type DRUG

650mg tabs. Take 3 tabs twice daily.

Litholyte

Intervention Type DIETARY_SUPPLEMENT

One packet is taken with 170ml of water. Two packets daily.

Crystal Lite

Intervention Type DIETARY_SUPPLEMENT

The classic lemonade contains 21.7mEq/liter of alkali Therefore, patients will take 2 litres daily to have the 40mEq of alkali daily needed.

Potassium Bicarbonate

Intervention Type DRUG

20 mEq tablets, one tablet twice daily

Crystal Lite

Group Type ACTIVE_COMPARATOR

Potassium citrate

Intervention Type DRUG

Slow release potassium citrate UroCit-K. Participants will take 20mEq twice daily.

Sodium bicarbonate

Intervention Type DRUG

650mg tabs. Take 3 tabs twice daily.

Litholyte

Intervention Type DIETARY_SUPPLEMENT

One packet is taken with 170ml of water. Two packets daily.

Crystal Lite

Intervention Type DIETARY_SUPPLEMENT

The classic lemonade contains 21.7mEq/liter of alkali Therefore, patients will take 2 litres daily to have the 40mEq of alkali daily needed.

Potassium Bicarbonate

Intervention Type DRUG

20 mEq tablets, one tablet twice daily

Potassium Bicarbonate

Group Type ACTIVE_COMPARATOR

Potassium citrate

Intervention Type DRUG

Slow release potassium citrate UroCit-K. Participants will take 20mEq twice daily.

Sodium bicarbonate

Intervention Type DRUG

650mg tabs. Take 3 tabs twice daily.

Litholyte

Intervention Type DIETARY_SUPPLEMENT

One packet is taken with 170ml of water. Two packets daily.

Crystal Lite

Intervention Type DIETARY_SUPPLEMENT

The classic lemonade contains 21.7mEq/liter of alkali Therefore, patients will take 2 litres daily to have the 40mEq of alkali daily needed.

Potassium Bicarbonate

Intervention Type DRUG

20 mEq tablets, one tablet twice daily

Interventions

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Potassium citrate

Slow release potassium citrate UroCit-K. Participants will take 20mEq twice daily.

Intervention Type DRUG

Sodium bicarbonate

650mg tabs. Take 3 tabs twice daily.

Intervention Type DRUG

Litholyte

One packet is taken with 170ml of water. Two packets daily.

Intervention Type DIETARY_SUPPLEMENT

Crystal Lite

The classic lemonade contains 21.7mEq/liter of alkali Therefore, patients will take 2 litres daily to have the 40mEq of alkali daily needed.

Intervention Type DIETARY_SUPPLEMENT

Potassium Bicarbonate

20 mEq tablets, one tablet twice daily

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Adults aged 18 and older.
* with or without a history of stone disease.

Exclusion Criteria

* They are unable to take any of the medications due to health reasons.
* Participants are pregnant or nursing.
* Participants are unable to adhere to the metabolic diet.
* Participants had a prior adverse event from one or more of the medications.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Texas Southwestern Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Brett Johnson

Associate Professor of Urology

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University of Texas Southwestern Medical Center

Dallas, Texas, United States

Site Status

Countries

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United States

Central Contacts

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Brett A Johnson, MD

Role: CONTACT

214-648-6853

Ashley Gonzalez, MD

Role: CONTACT

Facility Contacts

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Brett Johnson, MD

Role: primary

2146486853

References

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Scales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol. 2012 Jul;62(1):160-5. doi: 10.1016/j.eururo.2012.03.052. Epub 2012 Mar 31.

Reference Type BACKGROUND
PMID: 22498635 (View on PubMed)

Uribarri J, Oh MS, Carroll HJ. The first kidney stone. Ann Intern Med. 1989 Dec 15;111(12):1006-9. doi: 10.7326/0003-4819-111-12-1006.

Reference Type BACKGROUND
PMID: 2688503 (View on PubMed)

Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TM, White JR; American Urological Assocation. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24. doi: 10.1016/j.juro.2014.05.006. Epub 2014 May 20.

Reference Type BACKGROUND
PMID: 24857648 (View on PubMed)

Pak CY, Sakhaee K, Fuller C. Successful management of uric acid nephrolithiasis with potassium citrate. Kidney Int. 1986 Sep;30(3):422-8. doi: 10.1038/ki.1986.201.

Reference Type BACKGROUND
PMID: 3784284 (View on PubMed)

Ryall RL. Urinary inhibitors of calcium oxalate crystallization and their potential role in stone formation. World J Urol. 1997;15(3):155-64. doi: 10.1007/BF02201852. No abstract available.

Reference Type BACKGROUND
PMID: 9228722 (View on PubMed)

Preminger GM, Sakhaee K, Skurla C, Pak CY. Prevention of recurrent calcium stone formation with potassium citrate therapy in patients with distal renal tubular acidosis. J Urol. 1985 Jul;134(1):20-3. doi: 10.1016/s0022-5347(17)46963-1.

Reference Type BACKGROUND
PMID: 4009822 (View on PubMed)

Ettinger B, Pak CY, Citron JT, Thomas C, Adams-Huet B, Vangessel A. Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J Urol. 1997 Dec;158(6):2069-73. doi: 10.1016/s0022-5347(01)68155-2.

Reference Type BACKGROUND
PMID: 9366314 (View on PubMed)

Preminger GM, Sakhaee K, Pak CY. Alkali action on the urinary crystallization of calcium salts: contrasting responses to sodium citrate and potassium citrate. J Urol. 1988 Feb;139(2):240-2. doi: 10.1016/s0022-5347(17)42374-3.

Reference Type BACKGROUND
PMID: 3339718 (View on PubMed)

Stern KL, Canvasser N, Borofsky M, Gleason VM, Kamphuis G, El Tayeb MM, Hsi R, Scotland KB. Alkalinizing Agents: A Review of Prescription, Over-the-Counter, and Medical Food Supplements. J Endourol. 2020 Jan;34(1):1-6. doi: 10.1089/end.2019.0292. Epub 2019 Sep 25.

Reference Type BACKGROUND
PMID: 31333065 (View on PubMed)

Other Identifiers

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STU-2020-0613

Identifier Type: -

Identifier Source: org_study_id

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