Abstract: TH-OR054
Long-Term Outcomes and Health Care Costs of Fruits and Vegetables vs. Sodium Bicarbonate or Usual Care for Metabolic Acidosis in CKD: Post Hoc Analysis of a 10-Year Randomized Trial
Session Information
- CKD Outcomes: Novel Biomarkers, Interventions, and Multiorgan Crosstalk
October 22, 2026 | Location: Mile High Ballroom 1D, Convention Center
Abstract Time: 05:50 PM - 06:00 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Goraya, Nimrit, Baylor Scott and White Central Texas, Temple, Texas, United States
- Aksan, Nazan, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Kahlon, Maninder, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Simoni, Jan, Texas Tech University System, Lubbock, Texas, United States
- Leprince, Inka, Pharmstat, Fremont, California, United States
- Li, Elizabeth, Pharmstat, Fremont, California, United States
- Wesson, Donald E., The University of Texas at Austin Dell Medical School, Austin, Texas, United States
Background
Oral sodium bicarbonate (NaHCO3) is standard treatment for metabolic acidosis(MA) in chronic kidney disease (CKD), but dietary acid reduction with base producing fruits and vegetables (F&V) may provide additional health benefits. In this post hoc analysis, we compared clinical outcomes that affect group quality of life and care costs in study participants with CKD stage 3 (G3) and metabolic acidosis treated with either F&V or NaHCO3 compared with Usual Care, assessed annually for ten years.
Methods
One hundred eight macroalbuminuric, non-diabetic G3 participants and MA (plasma total CO2 =22-24 mM) were matched and randomized to receive: F&V (n=36) to reduce dietary acid by half; oral NaHCO3 (HCO3, n=36) 0.3 mmol/kg/day; or Usual Care (UC, n=36) receiving standard CKD treatment. Participants were followed annually for ten years. The primary outcome was progression to kidney replacement therapy (KRT). Post hoc outcomes included hospitalizations (Hosp), emergency department visits (EDV), and total healthcare costs. Group differences were analyzed using Kruskal-Wallis and Dunn pairwise testing; mixed-effects regression models evaluated longitudinal treatment costs.
Results
During follow up, there were 115 Hosp, 166 EDV, and 34 progressed to KRT.Compared with usual care, F&V treatment was associated with fewer hospitalizations (14 vs. 64; p<0.001), fewer ED visits (20 vs. 88; p<0.001), and less progression to KRT (4 vs. 16; p<0.004). There was no difference between HCO3 and UC regarding Hosp (37, p=0.404 vs. UC), EDV (58, p=0.345 vs. UC) and progression to KRT (14, p=0.051 vs. UC). Total ten year costs were not different between groups, treatment costs for F&V (p<0.001) but not HCO3 (p=0.081) grew more slowly than UC. Based on mixed-effects model predictions scaled to group level, year ten annual care cost was 19.67% lower for F&V than Usual Care ($0.99M vs. $1.23M) and 5.16% lower for F&V than HCO3 ($1.03M vs. $1.09M).
Conclusion
The data support fewer hospitalizations, emergency department visits, and fewer participants progressing to KRT than UC in participants given F&V but not NaHCO3. The data suggest that F&V treatment of metabolic acidosis in patients with G3 CKD yields better group quality of life than NaHCO3 without higher group care costs despite the added cost of F&V.