title: A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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: Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas 76508, USA.
authors: Nimrit
authors: N
authors: Goraya
authors: Jan
authors: J
authors: Simoni
authors: Chan-Hee
authors: CH
authors: Jo
authors: Donald E
authors: DE
authors: Wesson
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects; D000138:Acidosis / Q000175:diagnosis / Q000178:diet therapy* / Q000188:drug therapy* / Q000209:etiology; D000284:Administration, Oral; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood / Q000652:urine; D004032:Diet / Q000009:adverse effects; D005260:Female; D005638:Fruit; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000178:diet therapy* / Q000188:drug therapy* / Q000209:etiology; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D014675:Vegetables
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015415:Biomarkers; D017693:Sodium Bicarbonate; D011188:Potassium
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