A study depicted that in gout patients receiving benzbromarone therapy, the use of citrate mixture is better than sodium bicarbonate in minimizing gout attack frequency, and the occurrence of urine occult blood. However, the citrate mixture shows comparable efficacy to sodium bicarbonate on urine alkalization without any substantial adverse effects.

A randomized, parallel controlled, prospective study was carried to investigate the safety and efficacy of citrate mixture (50% citric acid, 10% potassium citrate, 20% sodium carbonate, 10% sodium citrate ) and sodium bicarbonate on urine alkalization in 200 gout subjects receiving benzbromarone therapy.

Participants were randomly assigned to either the sodium bicarbonate group (3 g/day, n=100) or the citrate mixture group (7 g/day, n=100). In addition, all the participants were initially given benzbromarone (25 mg/day) and then maintained at a dose of 50 mg per day. The biochemical and clinical data were gathered at baseline, and weeks two, four, eight, and 12. The primary outcome parameter was the alteration and distribution of urine pH.

Overall, 182 participants completed the 12-week urine alkalization trial. The urine pH value of both the cohorts considerably raised from the baseline to the final follow-up. The median urine pH value raised by 7.2% in the citrate mixture group (from 5.53 to 5.93) and by 9.1% in the sodium bicarbonate arm (from 5.50 to 6.00).

For each time point, the urine pH demonstrated no vital differences. The estimated glomerular filtration rate considerably declined after 12 weeks of therapy in the sodium bicarbonate cohort, while it displayed similarity between baseline and the last follow-up in subjects receiving citrate mixture.

According to the findings of the urine analysis, the occurrence of occult blood in the sodium bicarbonate recipients was elevated compared to the citrate mixture recipients, accompanied by same incidence of kidney stones. After 12 weeks, the frequency of twice gout flare witnessed in the citrate mixture arm was considerably lower compared to the sodium bicarbonate group, as shown in the following table:

No treatment-linked adverse events were witnessed. Thus, the citrate mixture is better than sodium bicarbonate to reduce the gout attack frequency.