Fruits, veggies reduced dialysis in CKD, but bicarbonate did not

Clinical takeaway: Diet is worth raising with stage 3 CKD patients who have mild acidosis: fruits and vegetables lowered kidney replacement therapy against usual care, and bicarbonate did no better than usual care, based on a small study. 

Oral sodium bicarbonate is a common treatment for metabolic acidosis in chronic kidney disease (CKD). Base-producing fruits and vegetables can trim dietary acid by the same amount and may add health benefits bicarbonate does not. A post hoc analysis of a randomized trial tests whether food earns that extra credit on outcomes tied to quality of life and care costs, from hospital stays to kidney replacement therapy. 

Among macroalbuminuric, non-diabetic stage 3 patients on usual care, more than four in 10 progressed to dialysis or transplant over 10 years. On fruits and vegetables, about one in 10 did. Bicarbonate landed near usual care, with nearly four in 10 progressing. 

On post hoc measures, fruits and vegetables cut hospitalizations and emergency department visits by roughly three-quarters against usual care. Bicarbonate showed no difference on either. 

Costs over 10 years did not differ across groups. Projected annual cost in year 10 ran about one-fifth lower with fruits and vegetables than with usual care, a model estimate scaled to the group level. 

The trial randomized 108 adults with stage 3 CKD, macroalbuminuria, and mild metabolic acidosis, 36 per arm, to fruits and vegetables, oral sodium bicarbonate, or usual care, meaning standard CKD treatment without added acid reduction. Participants were followed annually for 10 years, and hospitalizations, emergency department visits, and costs were analyzed post hoc. 

“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, MD, 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,” Goraya concluded. “They also highlight the potential quality-of-life and health-system value of investing in fruits and vegetables as a treatment strategy, particularly when favorable clinical outcomes can be achieved without increasing overall costs.” 

Source: Goraya N, et al. (2026 Oct 22) ASN Kidney Week 2026. Long-Term Outcomes and Health Care Costs of Fruits and Vegetables vs. Sodium Bicarbonate or Usual Care for Metabolic Acidosis in CKD: Post Hoc Analysis of a 10-Year Randomized Trial