Abstract: FR-OR09
Dietary Acid Reduction with Fruits and Vegetables or Sodium Bicarbonate to Avoid or Delay Need for Kidney Replacement Therapy (KRT) in Patients Initially with Stage 3 CKD: A 10-Year Randomized Trial
Session Information
- CKD: Care Patterns and Novel Therapeutic Approaches
October 25, 2024 | Location: Room 25, Convention Center
Abstract Time: 05:50 PM - 06:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
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
Previous studies show that dietary acid reduction with addition of either base-producing fruits and vegetables (F&V) or oral sodium bicarbonate (NaHCO3) slowed eGFR decline in study participants with CKD stage 3 (G3) hypertension-associated CKD. We examined the comparative benefits of F&V vs. NaHCO3 to avoid or delay need for KRT, a goal of kidney protective therapy,
Methods
One hundred eight macroalbuminuric, non-diabetic G3 participants 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 randomized to F+V (n=36) to reduce dietary PRAL by half, oral NaHCO3 (HCO3, n=36) 0.4 mmol/kg bw/day to approximate the base-producing potential of F&V, or to Usual Care (UC, n=36). The primary outcome was the proportion in each group not lost to follow up who reached the need for KRT, whether or not they were alive after the 10-year follow up. We annually measured systolic blood pressure (Sys BP), eGFR, and urine albumin-to-creatinine ratio (UACR), the latter two parameters measured until the time participants began KRT.
Results
Baseline Sys BP, eGFR, and UACR were not different among groups. At 10 years, Sys BP was lower in F&V ([mean (SD)], 129.7 (5.2) mm Hg) than both, HCO3 [141.4 (5.4) mm Hg] and UC [134.2 (5.4), p< 0.01]). In addition, the F&V trajectory for UACR during follow up was lower (p< 0.01) than that for both HCO3 and UC. The likelihood of KRT when combining the two intervention groups, F&V and HCO3 (18/58 = 31.0%) relative to UC (16/31 = 51.6%), was not different (p > 0.05). When the intervention groups were NOT combined, those in the F&V arm (4/29=13.8%) had fewer participants reach KRT than those in UC or HCO3 (14/29 or 48.3%) at p<0.004
Conclusion
Dietary acid reduction with F&V but not oral NaHCO3 yielded fewer study participants reaching the need for KRT than UC, supporting greater kidney protection with ten years follow up in these participants with CKD and macroalbuminuria at study entry. Given previous data showing that F&Vs were associated with better improvement of cardiovascular disease risk indices than NaHCO3 (Am J Nephrol 49:438–448, 2019), these data support F&V over NaHCO3 as kidney protection for patients with CKD 3.