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Original ArticlesChronic Kidney Disease
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A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

Nimrit Goraya, Jan Simoni, Chan-Hee Jo and Donald E. Wesson
CJASN March 2013, 8 (3) 371-381; DOI: https://doi.org/10.2215/CJN.02430312
Nimrit Goraya
*Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas;
†Department of Internal Medicine and
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Jan Simoni
‡Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
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Chan-Hee Jo
*Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas;
§Department of Biostatistics, Scott and White Healthcare, Temple, Texas; and
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Donald E. Wesson
*Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas;
†Department of Internal Medicine and
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Summary

Background and objectives Current guidelines recommend Na+-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) < 22 mM. Because diets in industrialized societies are typically acid-producing, we compared base-producing fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury.

Design, setting, participants, & measurements Individuals with stage 4 (eGFR, 15–29 ml/min per 1.73 m2) CKD due to hypertensive nephropathy, had a PTCO2 level < 22 mM, and were receiving angiotensin-converting enzyme inhibition were randomly assigned to 1 year of daily oral NaHCO3 at 1.0 mEq/kg per day (n=35) or fruits and vegetables dosed to reduce dietary acid by half (n=36).

Results Plasma cystatin C–calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; P<0.01) and the fruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; P<0.01), consistent with improved metabolic acidosis, and was higher in the HCO3 than the fruits and vegetable group (P<0.001). One-year urine indices of kidney injury were lower than baseline in both groups. Plasma [K+] did not increase in either group.

Conclusions One year of fruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia.

  • Received March 7, 2012.
  • Accepted October 29, 2012.
  • Copyright © 2013 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 8 (3)
Clinical Journal of the American Society of Nephrology
Vol. 8, Issue 3
March 07, 2013
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A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate
Nimrit Goraya, Jan Simoni, Chan-Hee Jo, Donald E. Wesson
CJASN Mar 2013, 8 (3) 371-381; DOI: 10.2215/CJN.02430312

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A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate
Nimrit Goraya, Jan Simoni, Chan-Hee Jo, Donald E. Wesson
CJASN Mar 2013, 8 (3) 371-381; DOI: 10.2215/CJN.02430312
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