Donald E Wesson
Texas A&M HSC College of Medicine, USA
Title: Treatment of metabolic acidosis in chronic kidney disease yields better weight control with fruits and vegetables than with currently recommended sodium-based alkali therapy
Biography
Biography: Donald E Wesson
Abstract
Background: Current guidelines recommend sodium-based alkali therapy for metabolic acidosis in chronic kidney disease (CKD) but recent data support that base-producing fruits and vegetables (F+V) also improve metabolic acidosis in CKD. Because CKD increases cardiovascular risk, weight reduction in overweight CKD patients appears desirable given its cardiovascular and other benefi ts. A diet high in F+V might promote weight reduction as well as improve metabolic acidosis in CKD.
Methods: We randomized 108 subjects with CKD stage 3 estimated glomerular fi ltration rate (30-59 ml/min/1.73 m2), metabolic acidosis with plasma total CO2 (PTCO2) >22 but <24 mM, and baseline BMI >25 as follows: F+V (n=36) added to reduce dietary potential renal acid load (PRAL) 50%, oral NaHCO3 (HCO3, n=36) to reduce PRAL 50%, or no alkali (Usual Care, n=36). All received standard kidney protection measures and were followed for 5 years.
Results: Baseline PTCO2 (23.0±0.6, 23.1±0.6, and 23.0±0.5, p=0.62) and BMI (28.8±2.1, 28.3±2.0, and 28.2±2.1, p=0.45) were not diff erent among F+V, HCO3, and Usual Care, respectively. Five-year PTCO2 was higher in HCO3 (23.9±0.4 mM) and F+V (23.8±0.4 mM) than Usual Care (21.9±0.4 mM, p <0.01 vs. HCO3 and F+V). By contrast, fi ve-year BMI was lower (p<0.03) in F+V (26.6±1.7) than both HCO3 (28.4±1.9) and Usual Care (27.8±1.7).
Conclusions: Treating CKD patients with either NaHCO3 or F+V improved metabolic acidosis similarly but BMI was lowest with F+V. Better weight control with F+V than NaHCO3, the latter being the currently recommended treatment option, supports F+V as the preferred treatment strategy for metabolic acidosis in overweight CKD patients.