10-Year RCT Finds Fruits and Vegetables Cut Hospitalizations 78% Versus Usual Care in Stage 3 CKD

The trial randomized 36 patients each to fruits and vegetables targeting 50% dietary acid reduction, oral sodium bicarbonate at equivalent dose, or usual care, with annual follow-up for a decade. Primary clinical events included 115 total hospitalizations, 166 emergency visits, and 34 dialysis initiations. The diet arm showed 20 emergency visits and 4 dialysis cases versus 88 visits and 16 dialysis cases in usual care; bicarbonate produced no separation from usual care on any endpoint. No increase in overall health-system costs was reported for the diet group.

Prior Goraya-led studies from 2012-2014 demonstrated short-term bicarbonate-equivalent effects on GFR preservation with base-producing foods, yet lacked decade-long hard outcomes. This extension reveals downstream utilization benefits that medication arms failed to match, suggesting mechanisms beyond simple acid neutralization such as potassium or fiber effects on inflammation. The single-center design and modest sample limit generalizability, while the 10-year retention strengthens causal inference for the observed divergence.

Next steps require multicenter replication with blinded endpoint adjudication and formal cost-effectiveness modeling before KDIGO guideline updates. Population-level produce prescriptions could amplify gains if scalable without raising net expenditure.