A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate
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BACKGROUND AND OBJECTIVES: 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. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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.
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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 [101]
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- Authors
- Goraya, N., Simoni, J., Jo, C.-H., & Wesson, D. E.
- Affiliations
- Texas A&M University (US)
- Baylor Scott & White Medical Center - Temple (US)
- Corresponding author
- Goraya, Nimrit
- Jo, Chan-Hee
- Wesson, Donald E.
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2013-03
- Volume
- 8
- Issue
- 3
- Pages
- 371-381
- ISSN
- 1555-9041 (ISSN-L)
- PMC
- PMC3586961
- OpenAlex
- W2131658070
- Cited by
- 410
- References
- 37
- Citations by year
- 2026: 14 · 2025: 23 · 2024: 26 · 2023: 34 · 2022: 36 · 2021: 41 · 2020: 40 · 2019: 38 · 2018: 37 · 2017: 36 · 2016: 29 · 2015: 23 · 2014: 22 · 2013: 9 · 2012: 1
- FWCI
- 20.97
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Texas Tech University
- Topics
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Kidney Stones and Urolithiasis Treatments
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- metabolic acidosis, chronic kidney disease stage 4, hypertensive nephropathy, sodium bicarbonate, dietary acids, fruits and vegetables, estimated glomerular filtration rate, hyperkalemia, ACE inhibitors
- MeSH terms
- Acid-Base Equilibrium, Acidosis, Administration, Oral, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Diet, Female, Fruit, Glomerular Filtration Rate, Humans, Hypertension, Kidney, Male, Middle Aged, Potassium, Texas, Time Factors, Vegetables, Biomarkers, Treatment Outcome, Sodium Bicarbonate, Renal Insufficiency, Chronic
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