Abstract: SA-OR72
Effect of Dietary Acid Reduction with Fruits and Vegetables vs. Oral NaHCO3 on Parameters of Cardiovascular Health in Stage 1 CKD: A 5-Year Randomized Trial
Session Information
- Nutritional and Lifestyle Interventions to Promote Health in CKD
November 04, 2023 | Location: Room 109, Pennsylvania Convention Center
Abstract Time: 05:06 PM - 05:15 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Authors
- Goraya, Nimrit, Baylor Scott and White Central Texas, Temple, Texas, United States
- Simoni, Jan, Texas Tech University System, Lubbock, Texas, United States
- Kahlon, Maninder, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Aksan, Nazan, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Wesson, Donald E., The University of Texas at Austin Dell Medical School, Austin, Texas, United States
Background
Patients with macroalbuminuric (urine albumin-to-creatinine ratio [ACR] > 200 mg/g cr) chronic kidney disease (CKD) have increased cardiovascular disease (CVD) risk. As high acid-producing diets are associated with increased CVD risk, we compared effects of base-producing fruits and vegetables (F+V) vs. oral NaHCO3 on contributors to cardiovascular health and on indices of CVD risk in participants with normal eGFR (> 90 ml/min/1.73 m2 or stage G1).
Methods
One hundred fifty-three macroalbuminuric, non-diabetic G1 participants on ACE inhibitors were randomized to receive F+V (n=51) in amounts to reduce dietary potential renal acid load 50%, oral NaHCO3 (HCO3, n=51) 0.4 meq/kg bw/day, or no additional intervention (Usual Care, n=51). They were followed annually for 5 years, measuring systolic blood pressure (SBP), eGFR, isoprostane 8-isoprostaglandin F2α (8-iso), BMI, ACR, and Lp(a). Mixed linear regressions with random person intercepts tested differential group trajectories, p-values from the relevant interaction terms are included below.
Results
We highlight group differences at year-5 for brevity and provide p-values from the full model. At 5 years, SBP and BMI were lower in F+V than HCO3 and UC (SBP [mean (SE)], F+V[128.9 (0.70)], HCO3 [135.0 (0.73)], UC [134.6 (0.62)], mm Hg, ps<0.001); BMI, F+V [27.0 (0.25)], HCO3 [28.4 (0.26)], UC [28.0 (0.30)], ps<0.001). For both F+V & HCO3 relative to UC, 5-year eGFR was higher (eGFR, F+V [96.5(0.79)], HCO3 [95.9 (0.96)] vs. UC [92.1 (1.23), ml/min/1.73 m2, ps<0.001]) and 8-iso was lower (8-iso, F+V [1.08 (0.02)], HCO3 [1.06 (0.02)] vs. UC [1.27 (0.03)], µg/g cr, ps<0.001]). Five-year Lp(a) was lower in F+V than HCO3 and UC (Lp(a), F+V [53.3 (1.2)], HCO3 [62.2 (1.4)], UC, [60.8 (1.5), mg/dl, ps<0.001]). Furthermore, 5-year ACR was lower for F+V and HCO3 than UC (F+V [306 (8.5)], HCO3 [308 (8.4)] vs. UC [416 (15), mg/g cr, ps<0.001]).
Conclusion
Dietary acid reduction with either F+V or NaHCO3 over 5 years yielded similar eGFR preservation, systemic oxidative stress reduction, and lower ACR benefits. Dietary acid reduction with F+V compared to NaHCO3 and UC yielded better SBP control, lower BMI and lower Lp(a) and yielded better overall CVD protection in macroalbuminuric patients with initially normal eGFR.