Can Delivering Fruits and Vegetables Address CKD Acidosis? With Navdeep Tangri, MD

Serum bicarbonate and safety measures did not differ significantly from oral sodium bicarbonate in a 36-person, 12-month trial.

Oral alkali therapy is recommended for metabolic acidosis in chronic kidney disease (CKD), but treatment rates remain low, largely because of side effects and poor tolerability.¹ A 12-month randomized trial tested weekly grocery delivery of base-producing fruits and vegetables as another option.

Navdeep Tangri, MD, professor of medicine at the University of Manitoba, presented the ReDACKD feasibility trial at the American Society of Nephrology (ASN) Kidney Week 2026 in Denver, Colorado. Most participants completed the full year. Serum bicarbonate did not differ significantly between produce delivery and sodium bicarbonate, although the trial was too small to show whether the 2 approaches are equally effective.¹

“I think clinicians should think about fruits and vegetables and sort of direct food delivery as a possible and viable alternative to medical therapy, and I shouldn’t say alternative. Perhaps I should say complementary to medical therapy,” Tangri said in an interview with HCPLive. “I’m a very evidence-based, clinical trials-based person. I think medical therapy is terrific, but I also think providing appropriate nutrition can also help lower risk factors and work together with the medicine and work safely.”

Testing Fruit and Vegetable Delivery Against Sodium Bicarbonate

Metabolic acidosis is a common complication of CKD and is associated with accelerated disease progression. Although guidelines recommend oral alkali therapy, investigators noted that tolerability concerns, including the risk of worsening hypertension, limit its use.¹

Earlier work by Nimrit Goraya, MD, Donald E. Wesson, MD, and colleagues found that 1 year of fruits and vegetables or sodium bicarbonate improved metabolic acidosis in people with stage 4 CKD due to hypertensive kidney disease, without producing hyperkalemia.³ Tangri said his team wanted to test the approach in a higher-risk population.

ReDACKD randomized adults at 2 centers, in Winnipeg and Halifax, Canada. Participants had an estimated glomerular filtration rate (eGFR) of 15–40 mL/min/1.73 m², 2 consecutive serum bicarbonate measurements of 14–22 mEq/L, and serum potassium < 5.3 mmol/L.¹ They received either weekly fruit and vegetable deliveries or oral sodium bicarbonate, which started at 1500 mg daily per the trial protocol.¹,²

Feasibility outcomes were recruitment rate, eligibility, and retention. Secondary outcomes included quality of life, physical function, blood pressure, and biochemical markers.¹

Sodium Bicarbonate Raised Serum Bicarbonate More, but Not Significantly

Of 56 participants assessed, 36 were randomized, 18 to each arm. Follow-up outcome data were available for 91.7% of participants. Completion was lower in the produce arm, where 13 of 18 participants finished the 12-month intervention, compared with 16 of 18 in the sodium bicarbonate arm.¹

Mean serum bicarbonate rose from 19.6 to 19.9 mEq/L with produce delivery and from 20.1 to 21.5 mEq/L with sodium bicarbonate. The adjusted between-group difference was −1.26 mEq/L (95% CI, −3.34 to 0.82; P = .23). Blood pressure, eGFR, serum potassium, hemoglobin A1c, and urine albumin-to-creatinine ratio did not differ significantly between groups.¹

Both groups’ mean bicarbonate remained below 22 mEq/L, the upper bound used for trial eligibility. With 36 participants, the trial was not designed to detect efficacy differences, and the confidence interval around the bicarbonate comparison was wide.

Investigators concluded that fruit and vegetable delivery is a feasible way to treat metabolic acidosis in CKD.¹ Tangri said the findings will likely form the foundation of a larger trial. He added that the delivery model could inform research in cardiovascular-kidney-metabolic (CKM) health, such as for patients who return to old eating patterns after a myocardial infarction or heart failure hospitalization.

Editors’ Note: Disclosures for Navdeep Tangri, MD, include AstraZeneca, Bayer, Boehringer Ingelheim, ClinPredict, Eli Lilly and Company, GSK, Janssen Pharmaceuticals, Klinrisk, Marizyme, Mesentech, Otsuka Pharmaceutical, ProKidney, PulseData, Quanta, Renibus Therapeutics, Roche, Tricida, and Vera.

References

1. Tangri N, Collister DTB, Balshaw R, et al. Reducing dietary acid with fruits and vegetables vs. oral alkali in people with CKD (ReDACKD): a randomized controlled feasibility trial. Abstract presented at: American Society of Nephrology Kidney Week 2026; October 22–25, 2026; Denver, CO. Abstract TH-PO1248. doi:10.1681/ASN.2026j3pzr03c

2. Mollard R, Cachero K, Luhovyy B, et al. Reducing dietary acid with fruit and vegetables versus oral alkali in people with chronic kidney disease (ReDACKD): a clinical research protocol. Can J Kidney Health Dis. 2023;10:20543581231190180. doi:10.1177/20543581231190180

3. Goraya N, Simoni J, Jo CH, Wesson DE. A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clin J Am Soc Nephrol. 2013;8(3):371-381. doi:10.2215/CJN.02430312