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J Am Soc Nephrol. 2015 Jul;26(7):1693-700. doi: 10.1681/ASN.2014040332. Epub 2015 Feb 12.

High Dietary Acid Load Predicts ESRD among Adults with CKD.

Author information

1
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California; banerjeet@medsfgh.ucsf.edu.
2
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
3
Department of Internal Medicine, Texas A&M College of Medicine and Scott and White Healthcare, Temple, Texas;
4
Kidney Epidemiology and Cost Center and.
5
Kidney Epidemiology and Cost Center and Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan;
6
Division of Diabetes Translation, Centers of Disease and Control and Prevention, Atlanta, Georgia; and.
7
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, San Francisco, California.

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 (NAEes), 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.

KEYWORDS:

ESRD; albuminuria; nutrition; risk factors

PMID:
25677388
PMCID:
PMC4483581
DOI:
10.1681/ASN.2014040332
[Indexed for MEDLINE]
Free PMC Article

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