Adding fruits and vegetables to the diet may help protect
the kidneys of patients with chronic kidney disease (CKD) with too much acid
build-up, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of
Nephrology (CJASN).
Western
diets that are based in animal and grain products are highly acidic and can
lead to metabolic acidosis, when too much acid builds up in the body. This is
particularly common in patients with CKD because the kidneys are responsible
for removing acid through the urine. Metabolic acidosis can cause rapid
breathing, confusion, and lethargy. Severe cases can lead to shock or death.
Alkali
supplementation therapy such as bicarbonate is used to treat CKD patients with
severe metabolic acidosis, but simply adding more fruits and vegetables --
which contain alkali -- to the diet might also help.
Nimrit
Goraya, MD, Donald Wesson, MD (Texas A&M College of Medicine) and their
colleagues tested this by randomizing 71 patients with hypertensive stage 4 CKD
to receive added fruits and vegetables or an oral alkaline medication for one
year. The treatments were dosed to decrease dietary acid by half.
Among the major findings:
•
Kidney function was similar between the two groups after one year.
•
One-year plasma total carbon dioxide (PTCO2) increased in both groups, which is
consistent with a lessening of metabolic acidosis. PTCO2 was higher in patients
receiving bicarbonate than in those receiving added fruits and vegetables.
•
Urine measurements of kidney injury were lower after one year in both groups.
•
Although fruits and vegetables are rich in potassium and might raise blood
potassium to dangerous levels, levels did not increase in either group.
"We
showed that by addition of alkali such as bicarbonate or alkali-inducing fruits
and vegetables, patients had a favorable response by reduction of urinary
kidney injury markers," said Dr. Wesson. "Our study suggests that
these interventions will help maintain kidney health in those with kidney
disease," added Dr. Goraya.
In
an accompanying editorial, Muhammad Yaqoob, MD (Bartshealth NHS Trust and
William Harvey Research Institute, in London) noted that the study is likely to
have a limited impact on clinical practice. "A small group of highly
motivated patients wishing to reduce their pill burden through dietary
modification may benefit from the results of this study.
However, many patients
find it difficult to follow a diet high in fruits and vegetables and might
therefore be more adherent to a supplement," he wrote. He added that a
large multicenter randomized controlled trial examining the impact of
supplemental bicarbonate, with and without dietary intervention, in patients
with chronic kidney disease is urgently needed.
References:
1.
N. Goraya, J. Simoni, C.-H. Jo, D.
E. Wesson. A Comparison of Treating
Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and
Vegetables or Sodium Bicarbonate. Clinical Journal of the American
Society of Nephrology, 2013; DOI: 10.2215/CJN.02430312
2.
American Society of Nephrology (ASN)
(2013, February 7). Fruits and vegetables may help protect the kidneys. ScienceDaily.
Retrieved April 23, 2013, from http://www.sciencedaily.com
/releases/2013/02/130207171737.htm
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