Baking Soda and Kidney Disease: It’s Not Just for Baking and Cleaning (Part 2)

This is the second part to a post on sodium bicarbonate and kidney disease. Part one was published on March 31st. It explored sodium bicarbonate. This part explores metabolic acidosis.

How Acidosis Affects Nutrition Status

Metabolic acidosis negatively affects nutrition status. The increased acid is associated with decreased blood protein levels, including albumin. In addition, it may contribute to bone disease.¹ Acidosis has also been associated with congestive heart failure, inflammation, and insulin resistance. Correction of acidosis is associated with increased albumin and protein levels, improved muscle mass, improved bone health, healthy weight gain, and fewer hospitalizations.^1,3 Correcting metabolic acidosis is a good thing and leads to improved overall health.

Does Diet Play a Role in Acidosis?

The common diet of Americans tends to be more acid-producing due to the higher intake of meat and lower intake of fruits and vegetables. ^2,5 Meat produces more acid, while fruits and vegetables produce more base.² Researchers have recently studied if changes in diet can improve acidosis in chronic kidney disease (CKD) patients. A 2012 study found that 30 days of added fruits and vegetables reduced kidney function decline similarly to supplementation with sodium bicarbonate in patients with CKD stage 1 and 2. ⁶ A 2013 study also compared fruit and vegetable intake to sodium bicarbonate supplementation in stage 4 hypertension-associated CKD patients over a 1 year period.⁵ Results showed that there were no differences in kidney function between the two groups after the year and concluded that fruits and vegetables improve metabolic acidosis. One concern for increased fruit and vegetable intake is causing high potassium levels in CKD patients. This 2013 study included participants that were at low risk for hyperkalemia (high potassium levels) and the participants in the fruits and vegetables group did not have high potassium issues at the end of the study.⁵ People who are at high risk for hyperkalemia should choose lower potassium fruits and vegetables and need to monitor their potassium intake. A Registered Dietitian can be a great help with this!

Summary

Sodium bicarbonate supplementation, more commonly known as baking soda, is a common treatment for metabolic acidosis in CKD patients, and has been shown to slow the progression of kidney disease. It is a safe treatment with few side effects. In addition, increasing the intake of fruits and vegetables has also been shown to improve metabolic acidosis in those with CKD. Your doctor monitors your blood work and will let you know if sodium bicarbonate would be right for you. It is not recommended to start sodium bicarbonate or any treatment without discussing it with your doctor. If you are on dialysis, your renal dietitian can also answer questions about your blood work. They can tell you about what fruits and vegetables would be best choices for you.

Read more about high alkaline diets and kidney disease in this previous blog post: “Dietary Acid Load and High Alkaline Diet Connection to Kidney Disease”.

References:

1. National Kidney Foundation: K/DOQI clinical practice guidelines for nutrition in chronic renal failure. American Journal of Kidney Diseases Volume 35, Issue 6, pS1-S140, 2000 (PDF version: http://www.kidney.org/sites/default/files/docs/kdoqi2000nutritiongl.pdf )
2. Bicarbonate Therapy for Prevention of Chronic Kidney Disease Progression. Igor Loniewski, Donald E. Wesson, Kidney International, Volume 85, p529-535, 2014
3. Current Status of Bicarbonate in CKD. Mirela Dobre, Mahboob Rahman, Thomas H. Hostetter, Journal of the American Society of Nephrology, Volume 26, p515-523, 2015
4. Daily Oral Sodium Bicarbonate Preserves Glomerular Filtration Rate by Slowing its Decline in Early Hypertensive Nephropathy. Ashutosh Mahajan, et al., Kidney International, Volume 78, p303-309, 2010
5. A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate. Nimrit Goraya, et al., Clinial Journal of the American Society of Nephrology, Volume 8, p371-381, 2013
6. 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, Nimrit Goraya, et al., Kidney International, volume 81, p86-93, 2012

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This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.