Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Sodium citrate is used in the management of uric acid retention, particularly in the context of gout and uric acid nephrolithiasis (kidney stones). Its primary mechanism is based on its ability to alkalinize urine. By increasing urinary pH, sodium citrate enhances the solubility of uric acid, thereby reducing the risk of uric acid crystallization and promoting its excretion. This approach is supported by established medical guidelines and has been validated in clinical settings, especially for patients who cannot tolerate or do not respond adequately to other uric acid-lowering therapies such as allopurinol.

Multiple clinical studies and reviews indicate that urine alkalinization, typically with potassium citrate but also with sodium citrate, effectively prevents the formation of uric acid stones and aids in their dissolution. The use of sodium citrate is especially suitable for patients who require sodium supplementation or cannot use potassium-based salts. However, direct high-quality randomized controlled trials specifically assessing sodium citrate’s efficacy for general uric acid retention (outside of stone prevention) are limited. Most of the evidence comes from its use in nephrolithiasis and as adjunctive therapy in gout management.

In summary, while the use of sodium citrate for uric acid retention is scientifically justified and supported by mechanistic rationale and clinical practice, the strength of evidence is moderate (rated 3/5) due to reliance on indirect evidence and a lack of large-scale, high-quality trials focused solely on sodium citrate for this indication.

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