Sodium bicarbonate 2.623g / Sodium citrate 939mg effervescent granules sachets

Sodium bicarbonate positively impacts performance, but its associated gastrointestinal symptoms (GIS) may limit use. This systematic review synthesized literature that has evaluated GIS with sodium bicarbonate supplementation. Literature searches were performed from February 2024-March 2026. Eligible studies provided ≥ 5 g of sodium bicarbonate within a 24-h period or, if a multi-day protocol, at least one day involving ≥ 5 g. Included studies had a placebo group/condition or a comparison group/condition that created a contrast related to delivery method, form, or dose. In total, 101 investigations were summarized in six categories: acute single dosing (n = 35); acute spread dosing (n = 28); chronic dosing (n = 7); acute versus chronic dosing (n = 5); delivery form (n = 18); and other (n = 8). Existing literature suggests that common acute doses (0.2-0.4 g/kg) elicit mild-to-severe GIS, which likely increase in a dose-dependent manner when sodium bicarbonate is ingested in a single dose. Strategies to reduce GIS with acute dosing include spreading intake over hours, using enteric-coated capsules/tablets, and ingesting sodium bicarbonate mini-tablets within a carbohydrate hydrogel. Direct comparisons of these strategies to reduce GIS are absent in current literature; thus, ranking their effectiveness is not possible. Multi-day dosing may lessen GIS, but symptom documentation throughout supplementation periods is poorly characterized. Notably, 26 of 101 studies failed to perform inferential statistical testing to examine condition/group differences in GIS. Making definitive recommendations about sodium bicarbonate supplementation to minimize GIS remains challenging. Major needs remain for direct comparisons between protocols purported to reduce GIS and improvements in GIS data collection, reporting, and analysis.

Abstract licence: CC BY-NC

BackgroundAutosomal dominant polycystic kidney disease (ADPKD), the leading monogenic cause of kidney failure, exhibits heterogeneous clinical progression. This systematic review and meta-analysis synthesize and evaluate current evidence on blood and urine prognostic biomarkers in ADPKD, addressing gaps in understanding their role in predicting progression and guiding clinical trial selection and management.MethodsWe searched PubMed, Embase, and Cochrane up to April 2025 and screened articles in duplicate. We included longitudinal studies evaluating the blood and urine prognostic biomarkers in patients with ADPKD with at least 10 participants and 1 year of follow-up. We used the Quality in Prognosis Studies tool to assess risk of bias, random effects meta-analyses to pool effect estimates, and the GRADE approach to assess the certainty of evidence.ResultsWe included 58 studies, with 33 urinary biomarkers and 29 serum/blood biomarkers identified. The most frequently studied biomarkers were urine osmolality, copeptin, proteinuria, Monocyte Chemoattractant Protein-1, and uric acid, whereas the most studied outcomes were estimated Glomerular Filtration Rate and Total Kidney Volume. The urinary biomarkers that showed the largest association with ADPKD were Monocyte Chemoattractant Protein-1, Kidney Injury Molecule-1, albumin, and Beta 2 microglobulin. Serum biomarkers associated with outcomes were primarily copeptin and Fibroblast Growth Factor-23, with β-Hydroxybutyrate and bicarbonate exhibiting lesser association.ConclusionIn conclusion, this systematic review highlights the potential prognostic value of blood and urine biomarkers in ADPKD. It also verified the need for further validation of biomarker use in ADPKD.Clinical trial numberNot applicable.

Abstract licence: CC BY-NC-ND

IntroductionFor critically ill patients requiring continuous renal replacement therapy, regional citrate anticoagulation is the preferred strategy to maintain extracorporeal circuit patency. Current clinical practice relies on two citrate-based protocols, with the widely used but complex 4% trisodium citrate solution posing a hypernatraemia risk and haemofiltration replacement fluid of sodium citrate offering procedural simplification and a more physiological electrolyte profile. Direct prospective comparison of their circuit lifespan efficacy is currently unavailable.Methods and analysisThis single-centre, prospective, open-label, parallel-group randomised controlled trial will be conducted in China. 90 patients will be enrolled and randomly assigned (1:1) to receive anticoagulation with either citrate-based haemofiltration replacement fluid or 4% trisodium citrate solution, with all patients undergoing a standardised continuous venovenous haemofiltration protocol. The primary outcome is circuit lifespan, with a non-inferiority margin set at 2.43 hours. Secondary outcomes include the 72-hour circuit survival probability, duration of hospitalisation, and all-cause mortality rates at 28 and 90 days. The primary analysis will follow the intention-to-treat principle.Ethics and disseminationThe study protocol has been approved by the Biomedical Research Ethics Committee of West China Hospital, Sichuan University (Approval No. (2025)1157). Any subsequent amendments must be submitted to the same ethics committee for further review and approval prior to implementation. Furthermore, the findings of this trial will be disseminated through presentations at relevant national and international conferences and via publication in peer-reviewed scientific journals.Trial registration numberChinese Clinical Trial Registry ChiCTR2500106991.

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