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

Goraya, Nimrit; Simoni, Jane M.; Jo, Chan‐Hee; Wesson, Donald E.

doi:10.1038/ki.2011.313

Cited by 275 publications

(235 citation statements)

References 31 publications

(45 reference statements)

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“…Similar findings have been reported elsewhere, with improvement in metabolic acidosis and phosphorus metabolism as possible mechanisms of action (41)(42)(43).…”

Section: Discussionsupporting

confidence: 77%

“…This could conceivably be extended to a CKD population, where numerous dietary trials involving protein restriction have been performed. Moreover, recent randomized trials involving high fruit and vegetable intake have shown safety and potential benefit in even advanced CKD, increasing the feasibility of a Mediterranean diet trial in this population (41,42). Strengths of this study include the duration of followup, a well characterized cohort, a valid food frequency questionnaire, adjustment for multiple confounders, and multiethnic composition that permits generalizability of results.…”

Section: Discussionmentioning

confidence: 99%

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The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Khatri¹,

Moon

Scarmeas

et al. 2014

Clinical Journal of the American Society of Nephrology

112

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Background and objectives Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function.Design, setting, participants, & measurements This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR,60 ml/min per 1.73 m 2 using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline ($2.5 ml/min per 1.73 m 2 per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors.Results Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m 2 . Incident eGFR,60 ml/min per 1.73 m 2 developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR,60 ml/min per 1.73 m 2 (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98).Conclusions A Mediterranean diet was associated with a reduced incidence of eGFR,60 ml/min per 1.73 m 2 and upper quartile of eGFR decline in a multiethnic cohort.

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“…Similar findings have been reported elsewhere, with improvement in metabolic acidosis and phosphorus metabolism as possible mechanisms of action (41)(42)(43).…”

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Khatri¹,

Moon

Scarmeas

et al. 2014

Clinical Journal of the American Society of Nephrology

112

View full text Add to dashboard Cite

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“…Goraya et al [66] conducted a prospective interventional study of a cohort of non-diabetic patients with stage 1 ( n = 79) and stage 2 CKD ( n = 120) due to hypertensive nephropathy. They substituted 50% daily acid load with either oral alkali (sodium bicarbonate: NaHCO 3 ) or fruits and vegetables.…”

Section: Interventions Targeting Risk Factors Of Inflammationmentioning

confidence: 99%

Inflammation: A Key Contributor to the Genesis and Progression of Chronic Kidney Disease

Qian

2017

Expanded Hemodialysis: Innovative Clinical Approach in Dialysis

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It has become apparent that inflammation and inflammatory reactions can evoke renal injury and promote chronic kidney disease (CKD) progression. Under physiological condition, intrarenal vascular distribution is heterogeneous, and medulla is hypoxic. To avoid energy deprivation in the low pO 2 regions of the kidney, an array of hormones, autocoids, and vasoactive substances, including medullipin, prostaglandins, endothelins, nitric oxide, angiotensin II, kinins, and adenosine, tonically regulates the microvasculature to ensure a perfect match of the microcirculation (O 2 supply) and renal tubules (O 2 demand). Inflammation, systemic or intrarenal, not only can abolish the microvascular response to its regulators, but also induces an array of tubular toxins, including reactive oxygen species, leading to tubular injury, nephron dropout, and onset of CKD. Positive acid balance, electrolyte alterations, and intestinal dysbiosis can perpetuate CKD progression. Understanding the role of inflammation in the genesis and progression of CKD will foster the development of strategies to prevent and treat the underlying inflammation and improve CKD outcomes.

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“…Strong evidence exists on the beneficial effects of a Mediterranean diet for incidence of several chronic diseases and reduced risk of mortality (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Mechanisms underlying these relationships include benefits of this dietary pattern on the cardiometabolic profile (e.g., adiposity, BP, blood lipids, serum fasting glucose, insulin resistance, and inflammation [20,21]) as well as on metabolic acidosis (22,23). Because such risk factors are highly prevalent in CKD and contribute to its onset, it is plausible to hypothesize that adoption of this healthy dietary lifestyle may link to better preserved renal function.…”

Section: Introductionmentioning

confidence: 99%

Mediterranean Diet, Kidney Function, and Mortality in Men with CKD

Huang

Jiménez-Moleón

Lindholm

et al. 2013

Clinical Journal of the American Society of Nephrology

124

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SummaryBackground and objectives Adherence to a Mediterranean diet may link to a better preserved kidney function in the community as well as a favorable cardiometabolic profile and reduced mortality risk in individuals with manifest CKD.Design, setting, participants, & measurements Dietary habits were determined by 7-day dietary records in a population-based cohort of 1110 Swedish men (age 70 years) from 1991 to 1995, 506 of whom were considered to have CKD because of a GFR,60 ml/min per 1.73 m 2 . A Mediterranean Diet Score was calculated, and participants were categorized as having low, medium, or high adherence. Adequate dietary reporters were identified with Goldberg cutoffs (n=597). Deaths were registered during a median follow-up of 9.9 years.Results Compared with low adherents, medium and high adherents were 23% and 42% less likely to have CKD, respectively (adjusted odds ratio [95% confidence interval]=0.77 [0.57 to 1.05] and 0.58 [0.38 to 0.87], respectively, P for trend=0.04). Among those individuals with CKD, phosphate intake and net endogenous acid production were progressively lower across increasing adherence groups. No differences were observed regarding other cardiometabolic risk factors across adherence groups. As many as 168 (33%) CKD individuals died during followup. Compared with low adherents, proportional hazards regression associated medium and high adherents to a 25% and 23% lower mortality risk, respectively (adjusted hazard ratio [95% confidence interval]=0.75 [0.52 to 1.06] and 0.77 [0.44 to 1.36], respectively, P for trend=0.10). Sensitivity analyses showed significant and stronger associations when only adequate dietary reporters were considered.Conclusions Adherence to a Mediterranean dietary pattern is associated with lower likelihood of CKD in elderly men. A greater adherence to this diet independently predicted survival in those patients with manifest CKD. Clinical trials are warranted to test the hypothesis that following such a diet could improve outcomes (independent of other healthy lifestyles) in CKD patients.

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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

Cited by 275 publications

References 31 publications

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Inflammation: A Key Contributor to the Genesis and Progression of Chronic Kidney Disease

Mediterranean Diet, Kidney Function, and Mortality in Men with CKD

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