Dietary acid load and chronic kidney disease among adults in the United States

Tanushree Banerjee, Deidra C. Crews, Donald E. Wesson, Anca Tilea, Rajiv Saran, Nilka Rios Burrows, Desmond E. Williams, Neil R. Powe

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Background: Diet can markedly affect acid-base status and it significantly influences chronic kidney disease (CKD) and its progression. The relationship of dietary acid load (DAL) and CKD has not been assessed on a population level. We examined the association of estimated net acid excretion (NAEes) with CKD; and socio-demographic and clinical correlates of NAEes. Methods. Among 12,293 U.S. adult participants aged >20 years in the National Health and Nutrition Examination Survey 1999-2004, we assessed dietary acid by estimating NAEesfrom nutrient intake and body surface area; kidney damage by albuminuria; and kidney dysfunction by eGFR < 60 ml/min/1.73m2using the MDRD equation. We tested the association of NAEeswith participant characteristics using median regression; while for albuminuria, eGFR, and stages of CKD we used logistic regression. Results: Median regression results (β per quintile) indicated that adults aged 40-60 years (β [95% CI] = 3.1 [0.3-5.8]), poverty (β [95% CI] = 7.1 [4.01-10.22]), black race (β [95% CI] = 13.8 [10.8-16.8]), and male sex (β [95% CI] = 3.0 [0.7- 5.2]) were significantly associated with an increasing level of NAEes. Higher levels of NAEescompared with lower levels were associated with greater odds of albuminuria (OR [95% CI] = 1.57 [1.20-2.05]). We observed a trend toward greater NAEesbeing associated with higher risk of low eGFR, which persisted after adjustment for confounders. Conclusion: Higher NAEesis associated with albuminuria and low eGFR, and socio-demographic risk factors for CKD are associated with higher levels of NAEes. DAL may be an important target for future interventions in populations at high risk for CKD.

Original languageEnglish (US)
Article number137
JournalBMC nephrology
Issue number1
StatePublished - Aug 24 2014
Externally publishedYes


  • Acidosis
  • Albuminuria
  • Chronic kidney disease
  • NHANES (National Health and Nutrition Examination Survey)
  • Nutrition

ASJC Scopus subject areas

  • Nephrology


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