Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas; Department of Internal Medicine, Baylor Scott and White Health, Temple, Texas.
Statistical Savvy Consulting, Georgetown, Texas.
J Ren Nutr. 2021 May;31(3):239-247. doi: 10.1053/j.jrn.2020.08.001. Epub 2020 Sep 18.
Current guidelines recommend treatment of metabolic acidosis in chronic kidney disease (CKD) with Na-based alkali but base-producing fruits and vegetables (F + V) might yield more and better health outcomes, making the intervention cost-effective.
In this post hoc analysis of a clinical trial we randomized 108 macroalbuminuric, nondiabetic CKD stage 3 participants with metabolic acidosis to receive F + V (n = 36) calculated to reduce dietary acid by half, oral NaHCO (HCO, n = 36) 0.3 mEq/kg body weight/day, or Usual Care (UC, n = 36) assessed annually for 5 years. We calculated a mean overall health score for the groups as follows: 1 for improved, 0 for no change, and -1 for worsened at 5 years for plasma total CO, 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 goal for estimated glomerular filtration rate (>30 mL/min/1.73 m) and systolic blood pressure (<130 mm Hg). We also assessed the number of participants with cardiovascular disease events (myocardial infarctions + strokes) and group medication and hospitalization costs.
Net plasma total CO increase at 5 years was no different between HCO and F + V. Average health scores at 5 years differed among groups (P < .01) with F + V (7.4 [mean] ± 1.6 [standard deviation]) being descriptively larger than HCO and UC (2.9 ± 1.6 and 1.2 ± 1.6, respectively). The number of participants suffering cardiovascular disease events differed among groups (P = .009) with none (0) in F + V, 6 in UC, and 2 in HCO. Total 5-year household cost per beneficial health outcome differed among groups (P = .005) with UC being highest and that for HCO and F + V being comparable.
Metabolic acidosis improved comparably with F + V or standard oral NaHCO, but F + V yielded ancillary beneficial health outcomes, fewer participants with adverse cardiovascular events, and per-household cost that was comparable to NaHCO.
目前的指南建议用 Na 基碱治疗慢性肾脏病（CKD）合并代谢性酸中毒，但产碱的水果和蔬菜（F+V）可能会带来更多更好的健康结果，使干预具有成本效益。
在这项临床试验的事后分析中，我们将 108 例伴有代谢性酸中毒的、非糖尿病的 CKD 3 期大量白蛋白尿患者随机分为三组：接受 F+V（n=36），以将饮食酸摄入量减少一半；接受口服 NaHCO（HCO，n=36），剂量为 0.3 mEq/kg 体重/天；或接受常规护理（UC，n=36），每年评估一次，为期 5 年。我们为各组计算了一个总体健康评分：5 年后，血浆总 CO、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、药物剂量变化（减少=1，增加=-1，不变=0）、估计肾小球滤过率（>30 mL/min/1.73 m2）达标（1 分）和未达标（0 分）、收缩压（<130 mm Hg）改善为 1 分，不变为 0 分，恶化为-1 分。我们还评估了心血管疾病事件（心肌梗死+中风）的发生情况和组内药物及住院费用。
5 年后 HCO 和 F+V 治疗组的净血浆总 CO 增加无差异。5 年后各组的平均健康评分不同（P<0.01），F+V 组（7.4[均值]±1.6[标准差]）明显大于 HCO 组和 UC 组（2.9±1.6 和 1.2±1.6）。各组间心血管疾病事件的发生人数不同（P=0.009），F+V 组无（0 例），UC 组 6 例，HCO 组 2 例。各组每获得一个有益健康结果的 5 年家庭总费用不同（P=0.005），UC 组最高，HCO 组和 F+V 组相当。
F+V 或标准口服 NaHCO 治疗代谢性酸中毒的效果相当，但 F+V 还带来了额外的有益健康结果，发生不良心血管事件的患者更少，家庭总费用与 NaHCO 相当。
