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Kidney Week

Abstract: FR-OR122

Treatment of Metabolic Acidosis in CKD with Fruits and Vegetables Yields Better Overall Health Outcomes Than Oral NaHCO3

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Goraya, Nimrit, Baylor Scott and White Health, Temple, Texas, United States
  • Simoni, Jan, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
  • Munoz Maldonado, Yolanda, Baylor Scott & White Health, Temple, Texas, United States
  • Wesson, Donald E., Diabetes Health and Wellness Institute, Dallas, Texas, United States
Background

Dietary acid reduction added to pharmacologic anti-angiotensin II therapy appears to provide adjunctive kidney protection and KDIGO guidelines recommend Na+-based alkali for treatment of metabolic acidosis in chronic kidney disease (CKD). Nevertheless, base-producing fruits and vegetables (F+V) also improve metabolic acidosis and might yield better overall health outcomes in patients with CKD than Na+-based alkali. We tested the hypothesis that F+V compared to oral NaHCO3 (HCO3) treatment of metabolic acidosis in CKD yielded better long-term (five years) health outcomes.

Methods

One hundred eight macroalbuminuric, non-diabetic CKD 3 subjects with metabolic acidosis but with serum [HCO3] between 22-24 meq/L were randomized to receive F+V (n=36) in amounts to reduce dietary potential renal acid load by half, oral NaHCO3 (HCO3, n=36) 0.3 meq/Kg bw/day, or to Usual Care (UC, n=36). All had a systolic blood pressure (SBP) goal < 130 mm Hg using drug regimens including ACE inhibition and were followed with annual assessments for five years. A score of 1 for improved, 0 for no change, and -1 for worsened at 5 years was assigned to the following 4 parameters: plasma total CO2 (PTCO2), LDL, HDL, and change in medication dose (a decrease in dose among the 7 possible medications was considered improved; an increase in dose was considered worsened). A score of 1 for met goal and 0 for not meeting goal was assigned to eGFR (goal > 30 ml/min/m2) and SBP (goal < 130 mm Hg) at five years.

Results

All three groups showed improved health outcomes during follow up (p<0.05) but the health score was greater than UC (1.17 ± 1.44) for both HCO3 and F+V (2.89 ± 1.70 and 7.39 ± 1.61, respectively, p<0.01). Additionally, the F+V health score was greater than HCO3 (p<0.01) due mostly to greater F+V than HCO3 reductions in medication (predominately anti-hypertensive) dosage, lower LDL, and a greater proportion of patients achieving SBP goal.

Conclusion

Treatment of metabolic acidosis in CKD with F+V and NaHCO3 yielded better overall health outcomes in CKD 3 patients than Usual Care but health outcomes were dramatically better in F+V than HCO3. The data support an overall long-term health advantage of F+V compared to HCO3 as a dietary acid reduction strategy for the treatment of metabolic acidosis in CKD 3.