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Cited by 399Renal function and acid-base balanceChronic Kidney Disease and DiabetesKidney Stones and Urolithiasis Treatments

Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate

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Goraya, Nimrit, Simoni, Jan, Jo, Chan-Hee, Wesson, Donald E.·2014·Kidney International
DOI 10.1038/ki.2014.83
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Abstract

Alkali therapy of metabolic acidosis in patients with chronic kidney disease (CKD) with plasma total CO2 (TCO2) below 22 mmol/l per KDOQI guidelines appears to preserve estimated glomerular filtration rate (eGFR). Since angiotensin II mediates GFR decline in partial nephrectomy models of CKD and even mild metabolic acidosis increases kidney angiotensin II in animals, alkali treatment of CKD-related metabolic acidosis in patients with plasma TCO2 over 22 mmol/l might preserve GFR through reduced kidney angiotensin II. To test this, we randomized 108 patients with stage 3 CKD and plasma TCO2 22-24 mmol/l to Usual Care or interventions designed to reduce dietary acid by 50% using sodium bicarbonate or base-producing fruits and vegetables. All were treated to achieve a systolic blood pressure below 130 mm Hg with regimens including angiotensin converting enzyme inhibition and followed for 3 years. Plasma TCO2 decreased in Usual Care but increased with bicarbonate or fruits and vegetables. By contrast, urine excretion of angiotensinogen, an index of kidney angiotensin II, increased in Usual Care but decreased with bicarbonate or fruits and vegetables. Creatinine-calculated and cystatin C-calculated eGFR decreased in all groups, but loss was less at 3 years with bicarbonate or fruits and vegetables than Usual Care. Thus, dietary alkali treatment of metabolic acidosis in CKD that is less severe than that for which KDOQI recommends therapy reduces kidney angiotensin II activity and preserves eGFR.

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  • In patients with stage 3 or 4 CKD, treatment with sodium bicarbonate or fruits and vegetables dosed to reduce renal acid load by 50% ameliorates metabolic acidosis and indices of kidney injury without producing hyperkalemia.

    “Both treatments ameliorated metabolic acidosis and indices of kidney injury and did so without producing hyperkalemia.”

    From Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function (2020) · cites this paper as [102]

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Authors
Goraya, N., Simoni, J., Jo, C.-H., & Wesson, D. E.
Affiliations
Baylor Scott & White Medical Center - Temple (US)
Corresponding author
Wesson, Donald E.
ORCID
Venue
Kidney International
Publisher
Elsevier BV
Published
2014-11
Volume
86
Issue
5
Pages
1031-1038
ISSN
0085-2538 (ISSN-L)
DOI
10.1038/ki.2014.83
OpenAlex
W2014046186
Cited by
399
References
42
Citations by year
2026: 18 · 2025: 20 · 2024: 27 · 2023: 47 · 2022: 42 · 2021: 48 · 2020: 40 · 2019: 41 · 2018: 29 · 2017: 41 · 2016: 21 · 2015: 20 · 2014: 4
FWCI
22.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Kidney International (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Kidney Stones and Urolithiasis Treatments
Keywords
metabolic acidosis, chronic kidney disease stage 3, alkali therapy, sodium bicarbonate, fruits and vegetables, angiotensin II, estimated glomerular filtration rate, ACE inhibitors, cystatin C
MeSH terms
Acid-Base Equilibrium, Acidosis, Administration, Oral, Angiotensinogen, Bicarbonates, Diet, Female, Fruit, Glomerular Filtration Rate, Humans, Kidney, Male, Middle Aged, Time Factors, Vegetables, Biomarkers, Treatment Outcome, Renal Insufficiency, Chronic

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