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In people with chronic kidney disease (CKD), oral sodium bicarbonate is a standard treatment for metabolic acidosis (too much acid buildup in the body), but results from a recent clinical trial indicate that dietary acid reduction with base-producing fruits and vegetables may be a better option. The findings will be presented at ASN Kidney Week 2026, Oct. 22–25.

In the trial, 108 adults with stage 3 CKD and metabolic acidosis were randomized to receive fruits and vegetables (to reduce dietary acid by half), oral sodium bicarbonate (also to reduce dietary acid by half) or usual care (36 patients in each group). Participants were followed annually for 10 years.

During follow-up, there were 115 hospitalizations and 166 emergency department visits, and 34 patients needed dialysis. Compared with the usual care group, the fruits and vegetables group had fewer hospitalizations (14 versus 64), fewer emergency department visits (20 versus 88) and less progression to dialysis (four versus 16). There was no difference between those given sodium bicarbonate and those receiving usual care regarding these outcomes.

"Treatment of metabolic acidosis with fruits and vegetables was associated with more favorable long-term clinical outcomes and health care utilization than standard treatment with sodium bicarbonate or usual care, without increasing overall health-system or societal costs," said corresponding author Nimrit Goraya, M.D., of Baylor Scott and White Health.

"These findings support evaluating dietary interventions in chronic kidney disease not only at the individual-patient level but also at the population level, where the cumulative clinical and economic benefits may be substantial.

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