Treating Metabolic Acidosis in Chronic Kidney Disease to Prevent Adverse Kidney and Cardiovascular Outcomes

Upon completion, this project will determine if treatment of metabolic acidosis in non-diabetic study participants with reduced kidney function (chronic kidney disease \[CKD\] stage 3) associated with high blood pressure (hypertension) and macroalbuminuria, the latter indicating pronounced kidney injury, using either base-producing fruits and vegetables (F+V) or standard therapy for treatment of metabolic acidosis with the medication sodium bicarbonate (NaHCO3) 1) slows progression of CKD toward end-stage renal disease \[ESRD\]; 2) improves indices of cardiovascular disease (CVD) risk; and 3) better preserves plasma acid-base parameters. These studies are designed to compare the differential effects of treating the metabolic acidosis of CKD with F+Vs or NaHCO3 on kidney outcomes, including progression to ESRD, on indices of CVD risk and on plasma acid-base parameters.

Inclusion Criteria: 1. Non-malignant high blood pressure or hypertension 2. 18-70 yrs old 3. urine albumin-to-creatine ratio \> 200 mg/g creatinine 4. estimated glomerular filtration rate (eGFR) 30 to 59 ml/min/1.73 m2 5. Plasma total CO2 (PTCO2) \> 22 but \< 24 mmol/l 6. able to tolerate angiotensin converting enzyme \[ACE\] inhibition drug therapy because guidelines recommend it for patients with albuminuric CKD 7. non-smoking 8. greater than or equal to 2 primary care visits in the preceding year, indicating compliance 9. Able to provide informed consent. Exclusion Criteria: 1. Malignant hypertension or history thereof 2. primary kidney disease or findings consistent thereof such as \> 3 red blood cells per high powered field of urine or urine cellular casts 3. history of diabetes or fasting glucose greater than or equal to 110/mg/dl 4. history of hematologic disorders, malignancies, chronic infections, current pregnancy, history or clinical evidence of CVD 5. peripheral edema or diagnosis associated with edema such as heart/liver failure or nephrotic syndrome because of the sodium load that accompanies NaHCO3 therapy 6. baseline plasma potassium concentration \> 4.6 mmol/l to reduce the risk for hyperkalemia in those participants randomized to F+Vs which increases dietary potassium intake 7. taking, or unable to stop taking, drugs other than ACE inhibitors that limit urine potassium excretion 8. Unable to provide informed consent.