Alkaline Water: Help or Hype for Uric Acid and Cystine Urolithiasis?

• Published in: The Journal of urology Vol. 211; no. 2; pp. 276 - 284
• Main Authors: Piedras, Paul, Cumpanas, Andrei D, McCormac, Amanda, Lavasani, Seyed Amiryaghoub M, Gorgen, Antonio R H, Rojhani, Allen, Vu, Minh-Chau, Bhatt, Rohit, Asplin, John, Tano, Zachary E, Landman, Jaime, Clayman, Ralph V, Patel, Roshan M
• Format: Journal Article
• Language: English
• Published: United States 01-02-2024
• Subjects: uric acid stones; urolithiasis; complimentary therapies; alkalization
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1097/JU.0000000000003767

The consumption of alkaline water, water with an average pH of 8 to 10, has been steadily increasing globally as proponents claim it to be a healthier alternative to regular water. Urinary alkalinization therapy is frequently prescribed in patients with uric acid and cystine urolithiasis, and as such we analyzed commercially available alkaline waters to assess their potential to increase urinary pH.
Five commercially available alkaline water brands (Essentia, Smart Water Alkaline, Great Value Hydrate Alkaline Water, Body Armor SportWater, and Perfect Hydration) underwent anion chromatography and direct chemical measurements to determine the mineral contents of each product. The alkaline content of each bottle of water was then compared to that of potassium citrate (the gold standard for urinary alkalinization) as well as to other beverages and supplements used to augment urinary citrate and/or the urine pH.
The pH levels of the bottled alkaline water ranged from 9.69 to 10.15. Electrolyte content was minimal, and the physiologic alkali content was below 1 mEq/L for all brands of alkaline water. The alkali content of alkaline water is minimal when compared to common stone treatment alternatives such as potassium citrate. In addition, several organic beverages, synthetic beverages, and other supplements contain more alkali content than alkaline water, and can achieve the AUA and European Association of Urology alkali recommendation of 30 to 60 mEq per day with ≤ 3 servings/d.
Commercially available alkaline water has negligible alkali content and thus provides no added benefit over tap water for patients with uric acid and cystine urolithiasis.