Reducing Dietary Acid with Fruit and Vegetables in individuals with Diabetes and Chronic Kidney Disease (RaVe-DKD) trial

Type 2 diabetes (T2D) is the most common cause of Chronic Kidney Disease (CKD) in Canada. CKD can reduce a person's ability to manage the balance of acid and base in their bodies properly, leading to a condition called metabolic acidosis. T2D and metabolic acidosis are both more common in people who have advanced CKD. Metabolic acidosis increases the risk for dialysis and death from any cause in people with CKD. Currently, metabolic acidosis is treated by giving people sodium bicarbonate, also known as baking soda, in pills to help balance the extra acid the kidneys are not able to remove from the body. Patients often do not like the baking soda treatment and stop taking it. Metabolic acidosis can also be treated by reducing the acid that comes from the food a person eats. This is can be done with base forming foods which neutralize acids, such as fruits and vegetables. People with T2D must manage the amount of carbohydrate they eat, especially sugar, as carbohydrate can make blood sugar management difficult. Lower carbohydrate fruit and vegetables would be best suited for people with T2D, CKD and metabolic acidosis. In this two-year study, we will test whether the delivery of low carbohydrate fruits and vegetables to people living with T2D+CKD can treat metabolic acidosis. The fruit and vegetable treatment will be compared to the current usual care with baking soda in a randomized study. Participant will be recruited to this study from many places across Canada in what is called a multi-site trial. The study will look at the impact of the fruits and vegetables on a measure of kidney function called estimated glomerular filtration rate (eGFR), as well as other measures including quality of life. We will also conduct interviews at the end of the study with participants and their caregivers and ask them about the treatments, including what they liked and did not like. This study's results could change the care of metabolic acidosis in people with T2D and CKD.