Departments of Internal Medicine, Texas A&M College of Medicine, Temple, Texas, USA.
Departments of Internal Medicine, Baylor Scott and White Health, Temple, Texas, USA.
Am J Nephrol. 2019;49(6):438-448. doi: 10.1159/000500042. Epub 2019 Apr 17.
Current guidelines recommend treatment of metabolic acidosis in chronic kidney disease (CKD) with sodium-based alkali. We tested the hypothesis that treatment with base-producing fruits and vegetables (F + V) better improves cardiovascular disease (CVD) risk indicators than oral sodium bicarbonate (NaHCO3).
We randomized 108 macroalbuminuric, matched, nondiabetic CKD patients with metabolic acidosis to F + V (n = 36) in amounts to reduce dietary acid by half, oral NaHCO3 (HCO3, n = 36) 0.3 mEq/kg bw/day, or to Usual Care (UC, n = 36) to assess the 5-year effect of these interventions on estimated glomerular filtration rate (eGFR) course as the primary analysis and on indicators of CVD risk as the secondary analysis.
Five-year plasma total CO2 was higher in HCO3 and F + V than UC but was not different between HCO3 and F + V (difference p value < 0.01). Five-year net eGFR decrease was less in HCO3 (mean -12.3, 95% CI -12.9 to -11.7 mL/min/1.73 m2) and F + V (-10.0, 95% CI -10.6 to -9.4 mL/min/1.73 m2) than UC (-18.8, 95% CI -19.5 to -18.2 mL/min/1.73 m2; p value < 0.01) but was not different between HCO3 and F + V. Five-year systolic blood pressure was lower in F + V than UC and HCO3 (p value < 0.01). Despite similar baseline values, F + V had lower low-density lipoprotein, Lp(a), and higher serum vitamin K1 (low serum K1 is associated with coronary artery calcification) than HCO3 and UC at 5 years.
Metabolic acidosis improvement and eGFR preservation were comparable in CKD patients treated with F + V or oral NaHCO3 but F + V better improved CVD risk indicators, making it a potentially better treatment option for reducing CVD risk.
目前的指南建议用基于钠的碱来治疗慢性肾脏病（CKD）患者的代谢性酸中毒。我们检验了这样一个假设，即食用产碱的水果和蔬菜（F + V）比口服碳酸氢钠（NaHCO3）能更好地改善心血管疾病（CVD）风险指标。
我们将 108 例伴有代谢性酸中毒的、配对的、非糖尿病性 CKD 宏白蛋白尿患者随机分为 F + V 组（n = 36）、口服 NaHCO3 组（HCO3，n = 36）和常规治疗组（UC，n = 36），以评估这些干预措施在 5 年内对肾小球滤过率（eGFR）的影响。主要分析为原发性分析，次要分析为 CVD 风险指标。
5 年内，HCO3 和 F + V 组的血浆总 CO2 均高于 UC 组，但 HCO3 和 F + V 组之间没有差异（差异 p 值 < 0.01）。HCO3 组（-12.3，95%CI -12.9 至 -11.7 mL/min/1.73 m2）和 F + V 组（-10.0，95%CI -10.6 至 -9.4 mL/min/1.73 m2）的 5 年内 eGFR 下降幅度均小于 UC 组（-18.8，95%CI -19.5 至 -18.2 mL/min/1.73 m2；p 值 < 0.01），但 HCO3 和 F + V 组之间没有差异。5 年内，F + V 组的收缩压低于 UC 组和 HCO3 组（p 值 < 0.01）。尽管基线值相似，但与 HCO3 和 UC 相比，F + V 组的低密度脂蛋白（LDL）、脂蛋白（a）较低，血清维生素 K1 较高（低血清 K1 与冠状动脉钙化有关）。
在接受 F + V 或口服 NaHCO3 治疗的 CKD 患者中，代谢性酸中毒的改善和 eGFR 的维持效果相当，但 F + V 能更好地改善 CVD 风险指标，使其成为降低 CVD 风险的潜在更好的治疗选择。
