2014
DOI: 10.1038/ki.2014.83
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Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate

Abstract: Alkali therapy of metabolic acidosis in patients with chronic kidney disease (CKD) with plasma total CO2 (TCO2) below 22 mmol/l per KDOQI guidelines appears to preserve estimated glomerular filtration rate (eGFR). Since angiotensin II mediates GFR decline in partial nephrectomy models of CKD and even mild metabolic acidosis increases kidney angiotensin II in animals, alkali treatment of CKD-related metabolic acidosis in patients with plasma TCO2 over 22 mmol/l might preserve GFR through reduced kidney angioten… Show more

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Cited by 340 publications
(334 citation statements)
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References 43 publications
(77 reference statements)
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“…8 In addition, kidney protection provided by plantsourced protein in patients with CKD is associated with reduced urine excretion of angiotensinogen, 7 a marker of kidney AngII levels. 14 These data suggest that the benefits of vegetarian diets on nephropathy progression are mediated at least in part through AngII receptors and support the contention of Garneata et al 13 and other investigators [5][6][7] that vegetarian and possibly ketoanaloguesupplemented diets are kidney-protective interventions adjunctive to ACEIs. These data help guide further study on how these diets provide kidney protection.…”
supporting
confidence: 55%
See 3 more Smart Citations
“…8 In addition, kidney protection provided by plantsourced protein in patients with CKD is associated with reduced urine excretion of angiotensinogen, 7 a marker of kidney AngII levels. 14 These data suggest that the benefits of vegetarian diets on nephropathy progression are mediated at least in part through AngII receptors and support the contention of Garneata et al 13 and other investigators [5][6][7] that vegetarian and possibly ketoanaloguesupplemented diets are kidney-protective interventions adjunctive to ACEIs. These data help guide further study on how these diets provide kidney protection.…”
supporting
confidence: 55%
“…Small-scale studies support that addition of plantsourced protein, such as fruits and vegetables, improves metabolic acidosis, reduces kidney injury, and slows nephropathy progression. [5][6][7] The mechanisms by which changes in the quality of ingested protein might slow nephropathy progression are incompletely understood. Substituting non-nitrogen ketoanalogues might allow patients to realize the benefit of dietary protein while avoiding possible untoward effects of nitrogenous wastes.…”
mentioning
confidence: 99%
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“…A subsequent study of non-diabetic patients with CKD stage 3 ( n = 108) and with minimal metabolic acidosis (total plasma CO 2 : 22-24 mEq/L) [67] also showed consistent beneficial effects of alkali therapy or dietary acid reduction with fruits and vegetables on reducing inflammation and kidney injury. Notably, urine angio-tensinogen excretion was significantly reduced, and decline of estimated glomerular filtration rate significantly slowed with both interventions.…”
Section: Interventions Targeting Risk Factors Of Inflammationmentioning
confidence: 83%