Sodium citrate is a salt the body converts into base, making blood and urine less acidic. Where that is the actual problem — acid build-up from failing kidneys, urine too acidic to keep uric acid dissolved, kidney stones — the measured effects are real. Each unit of citrate arrives with three of sodium, nudging blood pressure upward. Stomach upset is common. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Serum bicarbonate (CO₂) | 24–26 mEq/L | Confirms acidosis corrected without overshoot |
| Serum sodium | 137–142 mmol/L | Detects sodium loading and hypernatremia |
| Serum potassium | 4.0–4.5 mmol/L | Alkalosis shifts potassium into cells |
| Home blood pressure (7-day average) | Below 120/80 mmHg | The primary sodium-load endpoint |
| eGFR | Above 90 mL/min/1.73 m²; otherwise own slope | The endpoint alkali therapy targets in kidney disease |
| 24-hour urine citrate | Above 640 mg/day, target 800–1,000 mg/day on therapy | The direct measure of whether the dose is working |
| 24-hour urine pH | 6.0–6.5 | Above 6.0 dissolves uric acid; above 6.8 precipitates calcium phosphate |
| 24-hour urine calcium | Below 200 mg/day | Sodium citrate does not lower it, unlike the potassium salt |
| 24-hour urine sodium | Below 100 mmol/day | The objective check on total sodium intake |
| Serum ionised calcium | 1.16–1.30 mmol/L | Citrate chelates calcium; alkalosis lowers the ionised fraction |
| Serum uric acid | 3.5–5.5 mg/dL | Sets the target urine pH for uric acid stone formers |
Cadence: Serum electrolytes and bicarbonate at four weeks and again at twelve weeks after any dose change; home blood pressure weekly through the first three months; urine pH by home strip twice weekly during titration; full 24-hour urine collection at three months and thereafter every six to twelve months.