Dietary nitrate load lowers blood pressure and renal resistive index in patients with chronic kidney disease: A pilot study
Abstract
Beetroot has a high concentration of inorganic nitrate, which can serially reduced to form nitrite and nitric oxide (NO) after oral ingestion. Increased renal resistive index (RRI) measured by Doppler ultrasonography is associated with higher cardiovascular mortality in hypertensive patients with reduced renal function over time defined as chronic kidney disease (CKD). Our aim was to investigate whether the supplementation of dietary nitrate by administration of beetroot juice is able to reduce blood pressure and renal resistive index (RRI) as prognostic markers for cardiovascular mortality in CKD patients. In a cross-over study design, 17 CKD patients were randomized to either a dietary nitrate load (300 mg) by highly concentrated beetroot juice (BJ) or placebo (water). Hemodynamic parameters as well as plasma nitrate concentration and RRI were measured before and 4 h after treatment. In this cohort, CKD was mainly caused by hypertensive or diabetic nephropathy. The mean eGFR was 41.6 ± 12.0 ml/min/m 2. Plasma nitrate concentrations were significantly increased after ingestion of BJ compared to control. Peripheral systolic and diastolic blood pressure as well as mean arterial pressure (MAP) were significantly reduced secondary to the dietary nitrate load compared to control (e.g. ΔMAP BJ = -8.2 ± 7.6 mmHg vs. ΔMAP control = -2.2 ± 6.0 mmHg, p = 0.012). BJ also led to significantly reduced RRI values (ΔRRI BJ = -0.03 ± 0.04 versus ΔRRI control = 0.01 ± 0.04; p = 0.017). Serum potassium levels were not altered secondary to the treatment. In this study, administration of the nitrate donor BJ led to significantly reduced RRI values and peripheral blood pressure which might be explained by release of the vasodilatator NO after oral intake. Whether supplementation of dietary nitrate in addition to routine pharmacologic therapy is able to decelerate progression of cardiovascular and renal disease in CKD, remains to be investigated.
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The effects of nitrate intake on renal function markers (eGFR and albuminuria) in CKD remain inconclusive.
“the effects on renal function markers (e.g., eGFR and albuminuria) remain inconclusive [220,221].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [220]
Small-scale studies have reported reductions in blood pressure and renal resistance index following nitrate intake in CKD.
“small-scale studies have reported reductions in blood pressure and renal resistance index following nitrate intake.”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [220]
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“However, the effects on renal function markers (e.g., eGFR and albuminuria) remain inconclusive [220,221].”
- Authors
- Kemmner, S., Lorenz, G., Wobst, J., Kessler, T., Wen, M., Günthner, R., Stock, K., Heemann, U., Burkhardt, K., Baumann, M., & Schmaderer, C.
- Affiliations
- TUM Klinikum (DE)
- Deutsches Herzzentrum München (DE)
- Corresponding author
- Kemmner, Stephan
- ORCID
- Venue
- Nitric Oxide
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 64
- Pages
- 7-15
- ISSN
- 1089-8603 (ISSN-L)
- OpenAlex
- W2580326274
- Cited by
- 74
- References
- 18
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 10 · 2023: 15 · 2022: 4 · 2021: 12 · 2020: 8 · 2019: 6 · 2018: 7 · 2017: 3
- FWCI
- 5.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nitric Oxide (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- dietary nitrate, beetroot juice, chronic kidney disease, blood pressure, renal resistive index, plasma nitrate, hypertension, cardiovascular mortality, renal function
- MeSH terms
- Aged, Blood Pressure, Female, Humans, Kidney, Male, Nitrates, Pilot Projects, Plant Extracts, Dietary Supplements, Beta vulgaris, Renal Insufficiency, Chronic
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