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2008T Fresenius Hemodialysis

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Jeffrey H. Burbank
Founder& CEO of NxStage

Publication:

Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy

Nimrit Goraya, Jan Simoni, Chanhee Jo and Donald E Wesson

Kidney International (2012) 81, 86–93; doi:10.1038/ki.2011.313;
published online 31 August 2011

Earlier published studies showed that Na+-based alkali therapy like NaHCO3 and Na Citrate slowed the rate of eGFR decline in subjects with moderately reduced and severely reduced eGFR due to hypertensive nephropathy. 

In these recently published studies, we found that one month base-inducing fruits and vegetables (F+V) as well as NaHCO3 each reduced urine indices of kidney injury in subjects with moderately (CKD stage 2) reduced eGFR and to similar degrees. 

The F+V but not NaHCO3 intervention also reduced systolic blood pressure, an apparent additional cardiovascular benefit.  

These findings were not unexpected because we found similar results in previously published studies showing that animal models of CKD given a diet that is analogous to F+V (i.e., it had soy-based protein that is base-inducing rather than casein that is acid-inducing and is the standard protein in rat chow) also had a reduction in urine parameters of kidney injury. 

The data suggest that the standard acid-inducing diets of industrialized societies exacerbate kidney injury in subjects with already-reduce eGFR and that reducing dietary acid with a diet containing more F+V reduces kidney injury and raises the possibility that this intervention is kidney protective. 

The Dietary Approaches to Stop Hypertension (DASH) diet is high in F+V, is recommended for all subjects with hypertension, and should be more frequently implemented in subjects with hypertension.  This F+V intervention avoids the Na+ of Na+-based alkali therapy that might exacerbate hypertension and/or volume control in subjects with reduced eGFR. 

Clinicians should exercise caution, however, in recommending F+V to subjects with severely reduced eGFR because of the risk for hyperkalemia given the increased K+ content of F+V.

We are exploring if F+V slows eGFR decline in subjects with reduced eGFR.