NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol TantisattamoNovel dietary and pharmacologic approaches for acid–base modulation to preserve kidney function and manage uremiaGoraya, Nimrita,b; Wesson, Donald E.c,dAuthor Information aTexas A&M College of Medicine bBaylor Scott and White Health, Temple cDepartment of Internal Medicine, Temple, and Texas A&M Health Sciences Center College of Medicine dThe Baylor Scott and White Health and Wellness Center, Dallas, Texas, USA Correspondence to Donald E. Wesson, MD, Baylor Scott and White Health and Wellness Center, Texas A&M Health Sciences Center College of Medicine, 4500 Spring Avenue, Dallas, TX 75216, USA. Tel: +1 214 865 3064; fax: +1 214 865 3070; e-mail: [email protected] Current Opinion in Nephrology and Hypertension: January 2020 - Volume 29 - Issue 1 - p 39-48 doi: 10.1097/MNH.0000000000000568 Buy Metrics Abstract Purpose of review We review mechanisms for chronic kidney disease (CKD) progression that might be addressed with nonpharmacologic and novel pharmacologic interventions as strategies by which to slow or even prevent CKD progression. Recent findings Evolving data support the contribution of the broad spectrum of disorders of acid (H+) accumulation, which we refer to as ‘H+ stress’, to CKD progression. Recent studies support that amelioration of H+ stress, including spectra of H+ accumulation that are insufficient to cause metabolic acidosis, is kidney-protective. In addition, gut-derived toxins appear to contribute to CKD progression and to the well described increased cardiovascular disease (CVD) risk in patients with CKD. Dietary and novel pharmacologic interventions hold promise as strategies to slow CKD progression through reducing levels of these gut-derived toxins. In addition, oxidative stress appears to mediate CKD progression and contributing factors like diet and cigarette smoking can exacerbate oxidative stress. Dietary changes and smoking cessation hold promise to favorably affect CKD progression by reducing kidney oxidative stress. Summary The urgent need to add to the traditional armamentarium of blood pressure control and antiangiotensin II pharmacologic therapy for kidney protection has led to investigations into additional kidney-protective strategies. Acid stress, a disordered gut microbiome, and oxidative stress each appear to contribute to CKD progression and can be potentially addressed by nonpharmacologic and novel pharmacologic interventions. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.