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A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate.
Clin J Am Soc Nephrol. 2013 Mar; 8(3):371-81.CJ

Abstract

BACKGROUND AND OBJECTIVES

Current guidelines recommend Na(+)-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) < 22 mM. Because diets in industrialized societies are typically acid-producing, we compared base-producing fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Individuals with stage 4 (eGFR, 15-29 ml/min per 1.73 m(2)) CKD due to hypertensive nephropathy, had a PTCO2 level < 22 mM, and were receiving angiotensin-converting enzyme inhibition were randomly assigned to 1 year of daily oral NaHCO3 at 1.0 mEq/kg per day (n=35) or fruits and vegetables dosed to reduce dietary acid by half (n=36).

RESULTS

Plasma cystatin C-calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; P<0.01) and the fruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; P<0.01), consistent with improved metabolic acidosis, and was higher in the HCO3 than the fruits and vegetable group (P<0.001). One-year urine indices of kidney injury were lower than baseline in both groups. Plasma [K(+)] did not increase in either group.

CONCLUSIONS

One year of fruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia.

Authors+Show Affiliations

Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas 76508, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23393104

Citation

Goraya, Nimrit, et al. "A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease With Fruits and Vegetables or Sodium Bicarbonate." Clinical Journal of the American Society of Nephrology : CJASN, vol. 8, no. 3, 2013, pp. 371-81.
Goraya N, Simoni J, Jo CH, et al. A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clin J Am Soc Nephrol. 2013;8(3):371-81.
Goraya, N., Simoni, J., Jo, C. H., & Wesson, D. E. (2013). A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clinical Journal of the American Society of Nephrology : CJASN, 8(3), 371-81. https://doi.org/10.2215/CJN.02430312
Goraya N, et al. A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease With Fruits and Vegetables or Sodium Bicarbonate. Clin J Am Soc Nephrol. 2013;8(3):371-81. PubMed PMID: 23393104.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. AU - Goraya,Nimrit, AU - Simoni,Jan, AU - Jo,Chan-Hee, AU - Wesson,Donald E, Y1 - 2013/02/07/ PY - 2013/2/9/entrez PY - 2013/2/9/pubmed PY - 2013/8/27/medline SP - 371 EP - 81 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 8 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Current guidelines recommend Na(+)-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) < 22 mM. Because diets in industrialized societies are typically acid-producing, we compared base-producing fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Individuals with stage 4 (eGFR, 15-29 ml/min per 1.73 m(2)) CKD due to hypertensive nephropathy, had a PTCO2 level < 22 mM, and were receiving angiotensin-converting enzyme inhibition were randomly assigned to 1 year of daily oral NaHCO3 at 1.0 mEq/kg per day (n=35) or fruits and vegetables dosed to reduce dietary acid by half (n=36). RESULTS: Plasma cystatin C-calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; P<0.01) and the fruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; P<0.01), consistent with improved metabolic acidosis, and was higher in the HCO3 than the fruits and vegetable group (P<0.001). One-year urine indices of kidney injury were lower than baseline in both groups. Plasma [K(+)] did not increase in either group. CONCLUSIONS: One year of fruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/23393104/A_comparison_of_treating_metabolic_acidosis_in_CKD_stage_4_hypertensive_kidney_disease_with_fruits_and_vegetables_or_sodium_bicarbonate_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=23393104 DB - PRIME DP - Unbound Medicine ER -