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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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    Figure 1.

    Cascade of the selection process for study patients. F+V, fruits and vegetables. “Not treated” patients were not considered in the reported analysis.

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    Figure 2.

    Box plots of plasma total CO2 (TCO2) (left) and 8-hour urine net acid excretion (8h NAE) (right) in patients with CKD stage 4 at baseline and 1-year follow-up. HCO3 recipients were given oral NaHCO3 at 1.0 mEq/kg lean body weight per day; the fruit and vegetable recipients were given fruits and vegetables in amounts designed to reduce potential renal acid load by half. The bottom and top of the boxes span the 25th and 75th percentile of data points. The dark bar within the box indicates the 50th percentile or median. The whiskers indicate 1.5 times the interquartile range from the lower and upper quartiles. F+V, fruits and vegetables; F/U, follow-up. *P<0.05 versus respective baseline; +P<0.05 versus respective HCO3 group.

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    Figure 3.

    Box plots of 8-hour urine excretion of cystatin C (8h Cys Ex) (left) and of creatinine (8h Cr Ex) (right) at baseline and 1-year follow-up. The bottom and top of the boxes span the 25th and 75th percentile of data points. The dark bar within the box indicates the 50th percentile or median. The whiskers indicate 1.5 times the interquartile range from the lower and upper quartiles. F+V, fruits and vegetables; F/U, follow-up. *P<0.05 versus respective baseline.

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    Figure 4.

    Box plots of plasma cystatin C–estimated GFR (cysGFR) (left) and of plasma creatinine–estimated GFR (crGFR) (right) at baseline and 1-year follow-up. The bottom and top of the boxes span the 25th and 75th percentile of data points. The dark bar within the box indicates the 50th percentile or median. The whiskers indicate 1.5 times the interquartile range from the lower and upper quartiles. F+V, fruits and vegetables; F/U, follow-up. *P<0.05 versus respective baseline.

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    Figure 5.

    Box plots of the 8-hour urine excretion of indices of kidney injury. Urine albumin (8h urine albumin) is in the left panel, urine N-acetyl β-d-glucosaminidase (8h UNAG) is in the middle panel, and urine TGF-β (8h UTGF) is in the right panel. The bottom and top of the boxes span the 25th and 75th percentile of data points. The dark bar within the box indicates the 50th percentile or median. The whiskers indicate 1.5 times the interquartile range from the lower and upper quartiles. F+V, fruits and vegetables; F/U, follow-up. *P<0.05 versus baseline; +P<0.05 versus HCO3.

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    Figure 6.

    Box plots of 8-hour urine aldosterone excretion (8h aldo) (left) and ratio of active (tetrahydrocortisol [THF]) to inactive (tetrahydrocortisone [THE]) urine cortisol metabolites (right) in CKD stage 4 at baseline and 1 year. The THF/THE ratio indirectly assesses 11β-hydroxysteroid dehydrogenase enzyme activity that converts glucocorticoids to inactive metabolites. Higher ratios indicate lower activity. The bottom and top of the boxes span the 25th and 75th percentile of data points. The dark bar within the box indicates the 50th percentile or median. The whiskers indicate 1.5 times the interquartile range from the lower and upper quartiles. F+V, fruits and vegetables; F/U, follow-up. *P<0.05 versus respective baseline; +P<0.05 versus HCO3.

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    Table 1.

    General patient characteristics by group at baseline and at 1-year follow-up

    CharacteristicBaseline1 YearHCO3 Group P Value: 1 Year versus BaselineFruits and Vegetables Group P Value:
1 Year versus Baseline
    HCO3 Group (n=35)Fruits and Vegetables Group (n=36)P Value for Fruits and Vegetables Group versus HCO3 GroupHCO3 Group (n=35)Fruits and Vegetables Group (n=36)P Value for Fruits and Vegetables Group versus HCO3 Group
    Men (%)51560.92—————
    Black/white/Hispanic (%)57/29/1456/31/14>0.99—————
    Age (yr)54.2±5.353.9±6.90.86—————
    Weight (kg)84.3±5.482.7±6.10.2484.4±5.078.0±5.3<0.010.87<0.01
    Systolic BP (mmHg)136.1±4.7136.3±4.80.88136.0±4.4131.7±3.3<0.010.84<0.01
    Plasma creatinine (mg/dl)3.9±0.33.9±0.90.994.2±0.34.1±1.00.49<0.01<0.01
    Plasma cystatin C (mg/L)4.1±0.34.1±0.90.994.4±0.34.3±1.00.60<0.01<0.01
    Potential renal acid load (mmol/d)59.0±6.562.1±6.80.0559.3±6.339.6±10.4<0.010.28<0.01
    Plasma [K+] (mEq/L)4.1±0.24.1±0.20.844.1±0.24.1±0.10.25<0.050.59
    8h U KV (mEq)18.9±3.520.0±3.70.1819.8±3.423.3±4.1<0.01<0.01<0.01
    FEK (%)45.8±13.149.3±13.90.2851.9±14.060.0±17.50.04<0.01<0.01
    Plasma [Na+] (mEq/L)139.9±1.2139.8±1.30.59140.0±1.2139.8±1.00.280.690.88
    8h U NaV (mEq)38.3±6.740.0±6.40.2943.1±8.535.9±6.0<0.01<0.01<0.01
    FENa (%)2.7±0.82.9±0.70.403.3±0.92.7±0.7<0.01<0.01<0.01
    Plasma aldosterone (pg/ml)117.4±12.9113.7±12.10.22101.6±9.8119.9±12.6<0.01<0.01<0.01
    • Unless otherwise noted, values are expressed as the mean ± SD. Patients in the HCO3 group were subsequently given oral NaHCO3, 1.0 mEq/kg body weight per day. Patients in the fruits and vegetables group were given fruits and vegetables in amounts designed to reduce potential renal acid load by 50%. Presented are P values for comparisons between the HCO3 and fruits and vegetables groups at baseline and at 1 year and the 1-year compared with baseline values within the HCO3 and fruits and vegetables groups. 8h U KV, 8-hour urine K+ excretion; FEK, urine fractional excretion of K+; 8h U NaV, 8-hour urine Na+ excretion; FENa, urine fractional excretion of Na+

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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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