Texas: Fruits and vegetables (F+V) provided more beneficial health outcomes in patients with chronic kidney disease (CKD) stage 3 in a cost-effective manner as compared to recommended sodium bicarbonate supplements, suggests a recent study in the Journal of Renal Nutrition. F+V or sodium bicarbonate supplements however produced comparable improvements in metabolic acidosis in these patients.
Current guideline recommends metabolic acidosis treatment in CKD patients with Na+-based alkali but base producing F+V might yield better and more health outcomes, making it a cost-effective intervention. Nimrit Goraya, Department of Internal Medicine, Baylor Scott and White Health, Temple, Texas, and colleagues, therefore, tested the hypothesis whether metabolic acidosis treatment in CKD with F + V yields ancillary health outcomes compared to standard recommended therapy with NaHCO3.
For the study, 108 macroalbuminuric, nondiabetic CKD stage 3 participants with metabolic acidosis patients were randomized to receive F + V (n = 36) calculated to reduce dietary acid by half, oral NaHCO3 (HCO3−, n = 36) 0.3 mEq/kg body weight/day, or Usual Care (UC, n = 36) assessed annually for 5 years. A mean overall health score were calculated in groups as follows: 1 for improved, 0 for no change, and −1 for worsened at 5 years for plasma total CO2, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, change in medication dose (reduction = 1, increased = −1, no change = 0), and 1 for met goal and 0 for not meeting the goal for estimated glomerular filtration rate (>30 mL/min/1.73 m2) and systolic blood pressure (<130 mm Hg).
The researchers also assessed the number of participants with cardiovascular disease events (myocardial infarctions + strokes) and group medication and hospitalization costs.
Key findings of the study include:
Net plasma total CO2 increase at 5 years was no different between HCO3− and F + V.
Average health scores at 5 years differed among groups with F + V (7.4 [mean] ± 1.6 [standard deviation]) being descriptively larger than HCO3− and UC (2.9 ± 1.6 and 1.2 ± 1.6, respectively).
The number of participants suffering cardiovascular disease events differed among groups with none (0) in F + V, 6 in UC, and 2 in HCO3−.
Total 5-year household cost per beneficial health outcome differed among groups with UC being highest and that for HCO3− and F + V being comparable.
"These studies show that dietary H+ reduction treatment of CKD-related metabolic acidosis with F + V and NaHCO3 yielded a comparable improvement of metabolic acidosis yet F + V yielded ancillary beneficial health benefits and did so cost-effectively," wrote the authors.
"The data support the need for follow-up studies to examine the apparently more comprehensive individual and population benefits of F + V in the growing CKD population, " they concluded.
The study, "Treatment of Chronic Kidney Disease-Related Metabolic Acidosis With Fruits and Vegetables Compared to NaHCO3 Yields More and Better Overall Health Outcomes and at Comparable Five-Year Cost," is published in the Journal of Renal Nutrition.
DOI: https://www.sciencedirect.com/science/article/pii/S1051227620302016