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Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate.
Am J Nephrol. 2019; 49(6):438-448.AJ

Abstract

BACKGROUND

Current guidelines recommend treatment of metabolic acidosis in chronic kidney disease (CKD) with sodium-based alkali. We tested the hypothesis that treatment with base-producing fruits and vegetables (F + V) better improves cardiovascular disease (CVD) risk indicators than oral sodium bicarbonate (NaHCO3).

METHODS

We randomized 108 macroalbuminuric, matched, nondiabetic CKD patients with metabolic acidosis to F + V (n = 36) in amounts to reduce dietary acid by half, oral NaHCO3 (HCO3, n = 36) 0.3 mEq/kg bw/day, or to Usual Care (UC, n = 36) to assess the 5-year effect of these interventions on estimated glomerular filtration rate (eGFR) course as the primary analysis and on indicators of CVD risk as the secondary analysis.

RESULTS

Five-year plasma total CO2 was higher in HCO3 and F + V than UC but was not different between HCO3 and F + V (difference p value < 0.01). Five-year net eGFR decrease was less in HCO3 (mean -12.3, 95% CI -12.9 to -11.7 mL/min/1.73 m2) and F + V (-10.0, 95% CI -10.6 to -9.4 mL/min/1.73 m2) than UC (-18.8, 95% CI -19.5 to -18.2 mL/min/1.73 m2; p value < 0.01) but was not different between HCO3 and F + V. Five-year systolic blood pressure was lower in F + V than UC and HCO3 (p value < 0.01). Despite similar baseline values, F + V had lower low-density lipoprotein, Lp(a), and higher serum vitamin K1 (low serum K1 is associated with coronary artery calcification) than HCO3 and UC at 5 years.

CONCLUSION

Metabolic acidosis improvement and eGFR preservation were comparable in CKD patients treated with F + V or oral NaHCO3 but F + V better improved CVD risk indicators, making it a potentially better treatment option for reducing CVD risk.

Authors+Show Affiliations

Departments of Internal Medicine, Texas A&M College of Medicine, Temple, Texas, USA. Departments of Internal Medicine, Baylor Scott and White Health, Temple, Texas, USA.Statistical Savvy Consulting, Georgetown, Texas, USA.Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.Department of Internal Medicine, Texas A&M Health Sciences Center College of Medicine, Dallas, Texas, USA, Donald.wesson@BSWHealth.org. Baylor Scott and White Health and Wellness Center, Dallas, Texas, USA, Donald.wesson@BSWHealth.org.

Pub Type(s)

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

Language

eng

PubMed ID

30995657

Citation

Goraya, Nimrit, et al. "Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better Than Sodium Bicarbonate." American Journal of Nephrology, vol. 49, no. 6, 2019, pp. 438-448.
Goraya N, Munoz-Maldonado Y, Simoni J, et al. Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate. Am J Nephrol. 2019;49(6):438-448.
Goraya, N., Munoz-Maldonado, Y., Simoni, J., & Wesson, D. E. (2019). Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate. American Journal of Nephrology, 49(6), 438-448. https://doi.org/10.1159/000500042
Goraya N, et al. Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better Than Sodium Bicarbonate. Am J Nephrol. 2019;49(6):438-448. PubMed PMID: 30995657.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate. AU - Goraya,Nimrit, AU - Munoz-Maldonado,Yolanda, AU - Simoni,Jan, AU - Wesson,Donald E, Y1 - 2019/04/17/ PY - 2019/01/31/received PY - 2019/03/14/accepted PY - 2019/4/18/pubmed PY - 2020/7/7/medline PY - 2019/4/18/entrez KW - Acid KW - Alkali KW - Bicarbonate KW - Cardiovascular disease risk KW - Chronic kidney disease KW - Chronic metabolic acidosis KW - Diet KW - Dietary alkali KW - Health outcomes KW - Metabolic acidosis KW - Myocardial infarction KW - Stroke SP - 438 EP - 448 JF - American journal of nephrology JO - Am J Nephrol VL - 49 IS - 6 N2 - BACKGROUND: Current guidelines recommend treatment of metabolic acidosis in chronic kidney disease (CKD) with sodium-based alkali. We tested the hypothesis that treatment with base-producing fruits and vegetables (F + V) better improves cardiovascular disease (CVD) risk indicators than oral sodium bicarbonate (NaHCO3). METHODS: We randomized 108 macroalbuminuric, matched, nondiabetic CKD patients with metabolic acidosis to F + V (n = 36) in amounts to reduce dietary acid by half, oral NaHCO3 (HCO3, n = 36) 0.3 mEq/kg bw/day, or to Usual Care (UC, n = 36) to assess the 5-year effect of these interventions on estimated glomerular filtration rate (eGFR) course as the primary analysis and on indicators of CVD risk as the secondary analysis. RESULTS: Five-year plasma total CO2 was higher in HCO3 and F + V than UC but was not different between HCO3 and F + V (difference p value < 0.01). Five-year net eGFR decrease was less in HCO3 (mean -12.3, 95% CI -12.9 to -11.7 mL/min/1.73 m2) and F + V (-10.0, 95% CI -10.6 to -9.4 mL/min/1.73 m2) than UC (-18.8, 95% CI -19.5 to -18.2 mL/min/1.73 m2; p value < 0.01) but was not different between HCO3 and F + V. Five-year systolic blood pressure was lower in F + V than UC and HCO3 (p value < 0.01). Despite similar baseline values, F + V had lower low-density lipoprotein, Lp(a), and higher serum vitamin K1 (low serum K1 is associated with coronary artery calcification) than HCO3 and UC at 5 years. CONCLUSION: Metabolic acidosis improvement and eGFR preservation were comparable in CKD patients treated with F + V or oral NaHCO3 but F + V better improved CVD risk indicators, making it a potentially better treatment option for reducing CVD risk. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/30995657/Fruit_and_Vegetable_Treatment_of_Chronic_Kidney_Disease_Related_Metabolic_Acidosis_Reduces_Cardiovascular_Risk_Better_than_Sodium_Bicarbonate_ L2 - https://www.karger.com?DOI=10.1159/000500042 DB - PRIME DP - Unbound Medicine ER -