1Tamworth Rural Referral Hospital, Tamworth, Australia
Aim: To explore if citrus juice could be a safe replacement for sodium bicarbonate in CKD.
Background: It is important to treat metabolic acidosis in CKD to reduce progression , osteodystophy, weight loss, sarcopenia and anaemia. However sodium bicarbonate can contribute to sodium load and possibly contributing to hypertension. Urinary citrate deficiency has been demonstrated in early stages of CKD and recent dietary advice emphasizes fruit and vegetable intake to buffer acidosis in place of sodium bicarbonate too. Citrus juice has the potential to fulfill both these roles.
Methods: 33 patients already on sodium bicarbonate for CKD with hypertension were encouraged to take high fruits and vegetable diet and citrus juice 2 tablespoons 3 to 4 times daily with meals was suggested and then the sodium bicarbonate was stopped. Serum K was checked one week later and then bloods were checked monthly with blood pressure , and urine albumin excretion checked. Students T test was applied to the results with p<0.1 considered as significant
Results: 15 males and 18 females in age groups 61 to 91 were included. 2 were in stage 5, 5 in stage 4 , 15 in stage 3 CKD and rest in stage 2 CKD. No significant differences in bicarbonate, K, Na, GFR , weights were seen while on the citrus juice compared to when on the sodium bicarbonate. No patient developed hyperkalaemia . Several had significant blood pressure reduction needing medication reduction.
Conclusion: Citrus Juice is at least as effective as sodium bicarbonate, did not cause hyperkalaemia, was palatable and cheap and lead to lower blood pressures in several patients.
Senior VMO Nephrologist, Physician at Tamworth hospital with interests in Dialysis, diabetes, CKD, stone disease and teaching