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Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate
Nimrit Goraya a , b , Yolanda Munoz-Maldonado c , Jan Simoni d , Donald E. Wesson e , f , *
17 April 2019
American Journal of Nephrology
Chronic metabolic acidosis, Diet, Myocardial infarction, Stroke, Bicarbonate, Dietary alkali, Metabolic acidosis, Health outcomes, Acid, Alkali, Cardiovascular disease risk, Chronic kidney disease
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 (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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500042 Am J Nephrol 2019;49:438–448Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.