TY - JOUR
T1 - High dietary acid load predicts ESRD among adults with CKD
AU - Disease Control and Prevention Chronic Kidney Disease Surveillance Team
AU - Banerjee, Tanushree
AU - Crews, Deidra C.
AU - Wesson, Donald E.
AU - Tilea, Anca M.
AU - Saran, Rajiv
AU - Ríos-Burrows, Nilka
AU - Williams, Desmond E.
AU - Powe, Neil R.
AU - Hsu, Chi Yuan
AU - Bibbins-Domingo, Kirsten
AU - McCulloch, Charles
AU - Grubbs, Vanessa
AU - Steffick, Diane
AU - Gillespie, Brenda
AU - Herman, William
AU - Robinson, Bruce
AU - Shahinian, Vahakn
AU - Yee, Jerry
AU - McClellan, William
AU - O'Hare, Ann
AU - Fava, Melissa
AU - Burrows, Nilka Rios
AU - Eberhardt, Mark
AU - Geiss, Linda
AU - Mondesire, Juanita
AU - Moore, Bernice
AU - Pavkov, Meda
AU - Rolka, Deborah
AU - Saydah, Sharon
AU - Waller, Larry
N1 - Publisher Copyright:
Copyright © 2015 by the American Society of Nephrology.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - 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,DALwas determined by 24-h dietary recall questionnaire. The development of ESRDwas 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 themiddle 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.
AB - 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,DALwas determined by 24-h dietary recall questionnaire. The development of ESRDwas 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 themiddle 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.
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U2 - 10.1681/ASN.2014040332
DO - 10.1681/ASN.2014040332
M3 - Article
C2 - 25677388
AN - SCOPUS:84934767676
SN - 1046-6673
VL - 26
SP - 1693
EP - 1700
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 7
ER -