Introduction: Beetroot has a high concentration of nitrate. In circulation nitrate converts to nitrite. Nitrite-derived NO is a potent vasodilatator. Increased renal resistive index (RI) are associated with higher mortality in patients with chronic kidney disease (CKD) and predict cardiovascular events in these patients. Here we investigated if the ingestion of beetroot juice can reduce RI-values.

Methods: Using a randomized cross-over study design 12 CKD patients were investigated within 4 hours (h) after one ingestion of dietary nitrate load (300 mg) by highly concentrated beetroot juice (30g beetroot powder dispended in 200 ml water) versus 200 ml water. Plasma nitrite concentration as well as renal segemental arterial RI in duplex doppler ultrasonography was measured before and 4 hours after ingestion of beetroot or water. BP was measured every 15 minutes within the 4 hours.

Results: In 12 CKD patients (7 females) the eGFR was 40.7±13.8 ml/min. Three patients had a hypertensive nephropathy, 2 diabetic nephropathy and 7 seven patients had a combined hypertensive/diabetic nephropathy.

The RI value was significantly reduced by beetroot ingestion (pre-beetroot RI=0.75±0.05 versus post-beetroot RI=0.72±0.05; pre-water RI=0.75±0.06 versus post-water RI=0.76±0.05; P=0.02).

Conclusion: Our findings suggest that the supplementation of pharmacologic therapy with diatary nitrate through beetroot juice could prevent cardiovascular events and progression of renal disease in CKD patients.