High Dietary Acid Load Predicts ESRD among Adults with CKD

Abstract

Small clinical trials have shown that a reduction in dietary acid load (DAL) improves kidney injury and slows kidney function decline; however, the relationship between DAL and risk of ESRD in a population-based cohort with CKD remains unexamined. We examined the association between DAL, quantified by net acid excretion (NAE es ), and progression to ESRD in a nationally representative sample of adults in the United States. Among 1486 adults with CKD age$20 years enrolled in the National Health and Nutrition Examination Survey III, DAL was determined by 24-h dietary recall questionnaire. The development of ESRD was ascertained over a median 14.2 years of follow-up through linkage with the Medicare ESRD Registry. We used the Fine-Gray competing risks method to estimate the association of high, medium, and low DAL with ESRD after adjusting for demographics, nutritional factors, clinical factors, and kidney function/damage markers and accounting for intervening mortality events. In total, 311 (20.9%) participants developed ESRD. Higher levels of DAL were associated with increased risk of ESRD; relative hazards (95% confidence interval) were 3.04 (1.58 to 5.86) for the highest tertile and 1.81 (0.89 to 3.68) for the middle tertile compared with the lowest tertile in the fully adjusted model. The risk of ESRD associated with DAL tertiles increased as eGFR decreased (P trend=0.001). Among participants with albuminuria, high DAL was strongly associated with ESRD risk (P trend=0.03). In conclusion, high DAL in persons with CKD is independently associated with increased risk of ESRD in a nationally representative population.

Dietary Patterns and CKD Progression

“…Their findings are supported by that of Scialla et al [21] who noted an association between higher NEAP and faster decline in kidney function among African Americans with hypertensive nephropathy. Additionally, an observational study by our group found an increased risk of CKD progression associated with higher baseline concentrations of dietary acid load [22] . We observed that in the US CKD population, higher levels of dietary acid load were associated with 3 times greater risk of ESRD as compared to those with lower levels (relative hazard (95% CI) 3.04 (1.58-5.86)).…”

Study of association of serum bicarbonate levels with mortality in chronic kidney disease

“…Eliichiro Kanda et al, study stated that patient with the lowest quartile of serum bicarbonate level show a high risk of chronic kidney disease progression compared with patients with high serum bicarbonate levels. [10][11][12][13][14][15] In present study group, many patients were in stage 4 and stage 5 have low serum bicarbonate level. Many patients in the study group had low serum bicarbonate level and only 07 patients were having high serum bicarbonate level who were in stage 3 and stage 4.…”

Recent important strategies in the management of chronic kidney disease

“…Banerjee et al [26] have clearly shown that dietinduced acid load is associated with increased risk of ESRF. They demonstrated that worsening of metabolic acidosis was highly significantly associated with a decrease in GFR and concluded that acidosis in CKD is independently associated with an increased risk of ESRF.…”

“…They demonstrated that worsening of metabolic acidosis was highly significantly associated with a decrease in GFR and concluded that acidosis in CKD is independently associated with an increased risk of ESRF. [26] Secondly, a recent study from the University of Manchester, UK, showed that small changes in blood acidity are associated with an increase in parathyroid secretion, resulting in removal of calcium and phosphate from bones with arterial metastatic deposition. [27] The optimal NaHCO 3 dose remains to be determined, but the current recommendations state a dose of 0.5 -1.0 mmol of NaHCO 3 /kg body weight in three divided doses per day, i.e.…”