Editorial Am J Nephrol 2018;47:171–173 Addressing Racial Disparity in the Progression of Chronic Kidney Disease: Prescribe More Fruits and Vegetables? Wei Chen a David A. Bushinsky a, b a Department of Medicine, Rochester, NY, USA; b Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Published online: March 13, 2018 Nephrolo gy American Journal of David A. Bushinsky Department of Pharmacology and Physiology University of Rochester School of Medicine and Dentistry 601 Elmwood Avenue, Box 675, Rochester, NY 14642 (USA) E-Mail david_bushinsky @urmc.rochester.edu © 2018 S. Karger AG, Basel E-Mail karger@karger.com www.karger.com/ajn DOI: 10.1159/000487716 Compared to ancestral human diets rich in plants which are metabolized to bases, contemporary diets dis- place many of these foods with animal proteins metabo- lized to acids. Adaptation to these dietary changes neces- sitates a marked increase in renal net acid excretion to maintain systemic acid-base balance. As kidneys fail, the ability to excrete acid diminishes and consumption of di- etary acids leads to acid retention and metabolic acidosis [1]. Metabolic acidosis, generally defined by a reduced serum bicarbonate concentration, since blood pH is rare- ly measured in clinical studies, predicts chronic kidney disease (CKD) progression [2]. Several studies have shown that the correction of metabolic acidosis with so- dium bicarbonate slows CKD progression [3]. The mech- anism by which metabolic acidosis leads to a more rapid renal decline is unclear, but may involve increased single nephron ammoniagenesis, generation of aldosterone, and/or endothelin 1 [1]. Dietary acid load (DAL) is associated with CKD pro- gression although this relationship is not as robust as that between low serum bicarbonate and CKD progression. In African Americans with hypertensive CKD, a higher DAL was associated with a faster decline in renal func- tion, but time-to-event analyses showed that there was no association with a composite of renal events, defined as end stage renal disease (ESRD) or doubling of serum cre- atinine from baseline [4]. Among patients with CKD stages 2–4 from the Chronic Renal Insufficiency Cohort, a higher DAL was associated with a greater risk of CKD progression only among those without diabetes [5]. In- terventional studies demonstrate that the addition of base-producing fruits and vegetables were comparable to sodium bicarbonate supplementation not only in correct- ing metabolic acidosis but in preserving renal function [3]. In a study of patients with hypertensive CKD stage 3 and a plasma bicarbonate level between 22 and 24 mEq/L, participants eating base-producing fruits and vegetables had a slower decline in renal function and decreased urine N-acetyl-β-D-glucosaminidase and angiotensino- gen compared to usual care, and results were comparable