Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate
Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate
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DOI：
10.1159/000500042
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Wesson, Donald E.
中科院分区：
文献类型：
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作者：
Goraya, Nimrit;Munoz-Maldonado, Yolanda;Wesson, Donald E.
背景：目前的指南推荐使用钠碱治疗慢性肾脏病(CKD)中的代谢性酸中毒。我们测试了这样一种假设，即与口服碳酸氢钠(NaHCO>；)相比，使用基地生产的水果和蔬菜(F+V)可以更好地改善心血管疾病(CVD)的风险指标。方法：我们随机将108例大量蛋白尿、匹配的非糖尿病CKD代谢性酸中毒患者随机分为F+V组(n=36)、口服NaHCO>；(HCO>；，n=36)0.3mEq/kg体重/天，或常规护理(UC，n=36)，以评估这些干预措施对估计肾小球滤过率(EGFR)病程的5年效果作为主要分析，并评估这些干预措施对CVD风险指标的影响作为次要分析。结果：HCO+GT组和F+V组5年血浆总CO高于UC组，但与F+V组比较差异无统计学意义(P>0.01)。HCO和GT；(平均值-12.3，95%CI-12.9至-11.7毫升/分/1.73米(2))和F+V(-10.0，95%CI-10.6至-9.4毫升/分/1.73米(2))较UC(-18.8，95%CI-19.5至-18.2毫升/分/1.73米(2)；p值和lt；0.01)减少较少；F+V组五年收缩压低于UC和HCO>；(P值均<0.01)。尽管基线值相似，但在5年时，F+V的低密度脂蛋白、Lp(A)低于HCO和GT；UC高于血清维生素K1(低血清K1与冠状动脉钙化相关)。结论：F+V或口服NaHCO>治疗的CKD患者代谢性酸中毒的改善和EGFR的保存具有可比性，但F+V更好地改善了CVD风险指标，使其成为降低CVD风险的潜在更好的治疗选择。
Background: 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 (NaHCO>). Methods: 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 NaHCO> (HCO>, 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. Results: Five-year plasma total CO was higher in HCO> and F + V than UC but was not different between HCO> and F + V (difference p value < 0.01). Five-year net eGFR decrease was less in HCO> (mean -12.3, 95% CI -12.9 to -11.7 mL/min/1.73 m(2)) and F + V (-10.0, 95% CI -10.6 to -9.4 mL/min/1.73 m(2)) than UC (-18.8, 95% CI -19.5 to -18.2 mL/min/1.73 m(2); p value < 0.01) but was not different between HCO> and F + V. Five-year systolic blood pressure was lower in F + V than UC and HCO> (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 HCO> and UC at 5 years. Conclusion: Metabolic acidosis improvement and eGFR preservation were comparable in CKD patients treated with F + V or oral NaHCO> but F + V better improved CVD risk indicators, making it a potentially better treatment option for reducing CVD risk.