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      Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate

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          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 (NaHCO<sub>3</sub>). 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 NaHCO<sub>3</sub> (HCO<sub>3</sub>, 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 CO<sub>2</sub> was higher in HCO<sub>3</sub> and F + V than UC but was not different between HCO<sub>3</sub> and F + V (difference p value < 0.01). Five-year net eGFR decrease was less in HCO<sub>3</sub> (mean –12.3, 95% CI –12.9 to –11.7 mL/min/1.73 m<sup>2</sup>) and F + V (–10.0, 95% CI –10.6 to –9.4 mL/min/1.73 m<sup>2</sup>) than UC (–18.8, 95% CI –19.5 to –18.2 mL/min/1.73 m<sup>2</sup>; p value < 0.01) but was not different between HCO<sub>3</sub> and F + V. Five-year systolic blood pressure was lower in F + V than UC and HCO<sub>3</sub> ( 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 HCO<sub>3</sub> and UC at 5 years. Conclusion: Metabolic acidosis improvement and eGFR preservation were comparable in CKD patients treated with F + V or oral NaHCO<sub>3</sub> but F + V better improved CVD risk indicators, making it a potentially better treatment option for reducing CVD risk.

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          Author and article information

          Am J Nephrol
          American Journal of Nephrology
          S. Karger AG
          June 2019
          17 April 2019
          : 49
          : 6
          : 438-448
          aDepartments of Internal Medicine, Texas A&M College of Medicine, Temple, Texas, USA
          bDepartments of Internal Medicine, Baylor Scott and White Health, Temple, Texas, USA
          cStatistical Savvy Consulting, Georgetown, Texas, USA
          dDepartment of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
          eDepartment of Internal Medicine, Texas A&M Health Sciences Center College of Medicine, Dallas, Texas, USA
          fBaylor Scott and White Health and Wellness Center, Dallas, Texas, USA
          Author notes
          *Donald E. Wesson, MD, MBA, Department of Internal Medicine, Texas A&amp;M College of Medicine, Baylor Scott and White Health and Wellness Center, 4500 Spring Avenue, Dallas, TX 75210 (USA), E-Mail
          500042 Am J Nephrol 2019;49:438–448
          © 2019 S. Karger AG, Basel

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          Page count
          Figures: 3, Tables: 3, Pages: 11
          Patient-Oriented, Translational Research: Research Article


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