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

• The Slow Burn: CKD Risk Factors for Incidence and Progression
  November 03, 2017 | Location: Room 395, Morial Convention Center
  Abstract Time: 05:54 PM - 06:06 PM

Category: Chronic Kidney Disease (Non-Dialysis)

• 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

• Goraya, Nimrit, Baylor Scott and White Health, Temple, Texas, United States

Nimrit Goraya, MD

• Simoni, Jan, Texas Tech University Health Sciences Center, Lubbock, Texas, United States

Jan Simoni,

• Munoz Maldonado, Yolanda, Baylor Scott & White Health, Temple, Texas, United States

Yolanda Munoz Maldonado,

• Wesson, Donald E., Diabetes Health and Wellness Institute, Dallas, Texas, United States

Donald E. Wesson,

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.