Abstract: SA-OR037
Dietary Acid Reduction with Fruits and Vegetables or Sodium Bicarbonate to Prevent Composite Adverse Outcomes in Patients with CKD Stage 3: A Ten-Year Randomized Trial
Session Information
- Exploring Dietary, Exercise, and Microbiome Interventions in CKD
November 08, 2025 | Location: Room 360A, Convention Center
Abstract Time: 04:30 PM - 04:40 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
- Leprince, Inka, Pharm Stat, Fremont, California, United States
- Li, Elizabeth, Pharm Stat, Fremont, California, United States
- Wesson, Donald E., The University of Texas at Austin Dell Medical School, Austin, Texas, United States
Background
Kidney protection using dietary acid reduction with either base-producing fruits and vegetables (F&V) or oral sodium bicarbonate (NaHCO3) slowed eGFR decline in patients with stage G3 CKD due to hypertension-associated nephropathy. F&V improved cardiovascular disease (CVD) risk indices, but NaHCO3 did not (AJN 49:438,2019). We examined the comparative benefits of F&V vs.NaHCO3 to avoid composite outcomes such as reducing mortality, including from CVD,as well as delaying or avoiding kidney replacement therapy (KRT).
Methods
One hundred eight macroalbuminuric, non-diabetic G3 patients with mean baseline eGFR ~39 ml/min/1.73 m2 and baseline high acid-producing diets (mean potential renal acid load [PRAL] ~61 mmol/day) were matched and randomized to receive: F&V (n=36) to reduce PRAL by half; oral NaHCO3 (HCO3, n=36) 0.3 mmol/kg/day to approximate the base-producing potential of F&V; or Usual Care (UC, n=36). Primary outcome was the proportion of patients in each group who progressed to KRT. Secondary outcome was the time to the composite event of death, CVD event , and/or KRT after 10-years follow up.Patients were assessed annually.
Results
Baseline systolic blood pressure, estimated glomerular filtration rate, and urine albumin-to creatinine ratio were comparable across groups. At the 10-year follow-up, 34 patients progressed to KRT, 6 died (all from CVD), and 13 experienced CVD events. The likelihood of requiring KRT was not significantly different for HCO3 vs. UC (Hazard Ratio [HR]=0.38,p=0.051), but lower for F&V vs. UC (HR=0.06, p<0.01), and lower for F&V vs HCO3 (HR=0.15, p<0.01). The likelihood of composite events was lower for HCO3 vs UC (HR= 0.24, p<0.01), lower for F&V vs. UC (HR =0.02, p<0.01), and lower for F&V vs. HCO3(HR=0.10, p<0.01).
Conclusion
Dietary acid reduction through F&V provides better protection against the need for KRT than NaHCO3 and UC. While both NaHCO3 and F&V reduced the risk of composite events relative to UC, F&V demonstrated a lower HR, indicating stronger protective effects. These findings support the use of F&V as a more effective strategy for kidney protection in patients with macroalbuminuric G3 CKD, based on its superior impact in reducing both the risk of KRT, death, and CVD events compared with NaHCO3.