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Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate.
Kidney Int. 2014 Nov; 86(5):1031-8.KI

Abstract

Alkali therapy of metabolic acidosis in patients with chronic kidney disease (CKD) with plasma total CO2 (TCO2) below 22 mmol/l per KDOQI guidelines appears to preserve estimated glomerular filtration rate (eGFR). Since angiotensin II mediates GFR decline in partial nephrectomy models of CKD and even mild metabolic acidosis increases kidney angiotensin II in animals, alkali treatment of CKD-related metabolic acidosis in patients with plasma TCO2 over 22 mmol/l might preserve GFR through reduced kidney angiotensin II. To test this, we randomized 108 patients with stage 3 CKD and plasma TCO2 22-24 mmol/l to Usual Care or interventions designed to reduce dietary acid by 50% using sodium bicarbonate or base-producing fruits and vegetables. All were treated to achieve a systolic blood pressure below 130 mm Hg with regimens including angiotensin converting enzyme inhibition and followed for 3 years. Plasma TCO2 decreased in Usual Care but increased with bicarbonate or fruits and vegetables. By contrast, urine excretion of angiotensinogen, an index of kidney angiotensin II, increased in Usual Care but decreased with bicarbonate or fruits and vegetables. Creatinine-calculated and cystatin C-calculated eGFR decreased in all groups, but loss was less at 3 years with bicarbonate or fruits and vegetables than Usual Care. Thus, dietary alkali treatment of metabolic acidosis in CKD that is less severe than that for which KDOQI recommends therapy reduces kidney angiotensin II activity and preserves eGFR.

Authors+Show Affiliations

Departments of Internal Medicine, Texas A&M College of Medicine, Scott and White Healthcare, Temple, Texas, USA.Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.Department of Biostatistics, Scott and White Healthcare, Temple, Texas, USA.Departments of Internal Medicine, Texas A&M College of Medicine, Scott and White Healthcare, Temple, Texas, USA.

Pub Type(s)

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

Language

eng

PubMed ID

24694986

Citation

Goraya, Nimrit, et al. "Treatment of Metabolic Acidosis in Patients With Stage 3 Chronic Kidney Disease With Fruits and Vegetables or Oral Bicarbonate Reduces Urine Angiotensinogen and Preserves Glomerular Filtration Rate." Kidney International, vol. 86, no. 5, 2014, pp. 1031-8.
Goraya N, Simoni J, Jo CH, et al. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. Kidney Int. 2014;86(5):1031-8.
Goraya, N., Simoni, J., Jo, C. H., & Wesson, D. E. (2014). Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. Kidney International, 86(5), 1031-8. https://doi.org/10.1038/ki.2014.83
Goraya N, et al. Treatment of Metabolic Acidosis in Patients With Stage 3 Chronic Kidney Disease With Fruits and Vegetables or Oral Bicarbonate Reduces Urine Angiotensinogen and Preserves Glomerular Filtration Rate. Kidney Int. 2014;86(5):1031-8. PubMed PMID: 24694986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. AU - Goraya,Nimrit, AU - Simoni,Jan, AU - Jo,Chan-Hee, AU - Wesson,Donald E, Y1 - 2014/04/02/ PY - 2013/07/30/received PY - 2014/01/01/revised PY - 2014/02/06/accepted PY - 2014/4/4/entrez PY - 2014/4/4/pubmed PY - 2015/7/2/medline SP - 1031 EP - 8 JF - Kidney international JO - Kidney Int VL - 86 IS - 5 N2 - Alkali therapy of metabolic acidosis in patients with chronic kidney disease (CKD) with plasma total CO2 (TCO2) below 22 mmol/l per KDOQI guidelines appears to preserve estimated glomerular filtration rate (eGFR). Since angiotensin II mediates GFR decline in partial nephrectomy models of CKD and even mild metabolic acidosis increases kidney angiotensin II in animals, alkali treatment of CKD-related metabolic acidosis in patients with plasma TCO2 over 22 mmol/l might preserve GFR through reduced kidney angiotensin II. To test this, we randomized 108 patients with stage 3 CKD and plasma TCO2 22-24 mmol/l to Usual Care or interventions designed to reduce dietary acid by 50% using sodium bicarbonate or base-producing fruits and vegetables. All were treated to achieve a systolic blood pressure below 130 mm Hg with regimens including angiotensin converting enzyme inhibition and followed for 3 years. Plasma TCO2 decreased in Usual Care but increased with bicarbonate or fruits and vegetables. By contrast, urine excretion of angiotensinogen, an index of kidney angiotensin II, increased in Usual Care but decreased with bicarbonate or fruits and vegetables. Creatinine-calculated and cystatin C-calculated eGFR decreased in all groups, but loss was less at 3 years with bicarbonate or fruits and vegetables than Usual Care. Thus, dietary alkali treatment of metabolic acidosis in CKD that is less severe than that for which KDOQI recommends therapy reduces kidney angiotensin II activity and preserves eGFR. SN - 1523-1755 UR - https://www.unboundmedicine.com/medline/citation/24694986/Treatment_of_metabolic_acidosis_in_patients_with_stage_3_chronic_kidney_disease_with_fruits_and_vegetables_or_oral_bicarbonate_reduces_urine_angiotensinogen_and_preserves_glomerular_filtration_rate_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)30399-9 DB - PRIME DP - Unbound Medicine ER -