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Randomized Controlled Trial
. 2025 Dec;125(12):3619-3630.
doi: 10.1007/s00421-025-05850-x. Epub 2025 Jun 21.

Acute sodium bicarbonate supplementation reduces the increase in markers of acute kidney injury during physical work in the heat

Abdulaziz A Masoud  1 , Zidong Li  2 , Michael R Deyhle  3   4 , Jason Siegler  5 , Jonathan Specht  3 , Zachary J McKenna  6 , Christine Mermier  3 , Fabiano Amorim  3
Affiliations
Randomized Controlled Trial

Acute sodium bicarbonate supplementation reduces the increase in markers of acute kidney injury during physical work in the heat

Abdulaziz A Masoud et al. Eur J Appl Physiol. 2025 Dec.

Abstract

Introduction: In response to metabolic acidosis, compensatory mechanisms are deployed by the kidney to maintain acid-base homeostasis. During physical work in the heat, kidney perfusion is reduced, and the metabolic cost of acid-base balance can make the kidneys more prone to acute kidney injury (AKI). Sodium bicarbonate ingestion (NaHCO3) may reduce metabolic acidosis and the risk of developing AKI.

Purpose: We tested the hypothesis that acute NaHCO3 supplementation reduces the increase in AKI markers during physical work in the heat.

Methods: In a randomized double-blinded placebo-controlled crossover design 8 participants (3 females) completed 2 h of walking at 65% of maximal heart rate in 40 °C and ~ 20% relative humidity (RH) with NaHCO3 (0.2 g/kg) or a placebo. Urine samples collected pre- and 1 h post-physical work were assayed for insulin-like growth factor binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinase 2 (TIMP-2), and neutrophil gelatinase-associated lipocalin (NGAL).

Results: The increase in IGFBP7 × TIMP-2 was lower with NaHCO3 (Δ log 2.77 ± 1.40 [pg/min]2) compared to placebo (Δ log 4.19 ± 1.77 [pg/min]2) (interaction: p = 0.05). NGAL increased from pre to 1 h post in the placebo (Δ log 2.55 ± 0.99 pg/min) and NaHCO3 (Δ log 1.94 ± 1.06 pg/min) trials (main effect of time: p < 0.001), but there was no main effect of condition (p = 0.19) or interaction (p = 0.08).

Conclusion: These findings suggest that acute NaHCO3 supplementation may be a beneficial intervention for individuals attempting to mitigate AKI risk during physical work in the heat.

Keywords: Kidney function; Occupational worker; Physical work.

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Conflict of interest statement

Declaration. Conflict of interest.: The authors declare no conflicts of interest.

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