High dietary acid load predicts ESRD among adults with CKD

Disease Control and Prevention Chronic Kidney Disease Surveillance Team, Neil R. Powe

Research output: Contribution to journalArticle

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,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.

Original languageEnglish (US)
Pages (from-to)1693-1700
Number of pages8
JournalJournal of the American Society of Nephrology
Volume26
Issue number7
DOIs
StatePublished - Jul 1 2015

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Chronic Kidney Failure
Acids
Kidney
Albuminuria
Nutrition Surveys
Medicare
Population
Registries
Demography
Clinical Trials
Confidence Intervals
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Nephrology

Cite this

Disease Control and Prevention Chronic Kidney Disease Surveillance Team, & Powe, N. R. (2015). High dietary acid load predicts ESRD among adults with CKD. Journal of the American Society of Nephrology, 26(7), 1693-1700. https://doi.org/10.1681/ASN.2014040332

High dietary acid load predicts ESRD among adults with CKD. / Disease Control and Prevention Chronic Kidney Disease Surveillance Team; Powe, Neil R.

In: Journal of the American Society of Nephrology, Vol. 26, No. 7, 01.07.2015, p. 1693-1700.

Research output: Contribution to journalArticle

Disease Control and Prevention Chronic Kidney Disease Surveillance Team & Powe, NR 2015, 'High dietary acid load predicts ESRD among adults with CKD', Journal of the American Society of Nephrology, vol. 26, no. 7, pp. 1693-1700. https://doi.org/10.1681/ASN.2014040332
Disease Control and Prevention Chronic Kidney Disease Surveillance Team, Powe NR. High dietary acid load predicts ESRD among adults with CKD. Journal of the American Society of Nephrology. 2015 Jul 1;26(7):1693-1700. https://doi.org/10.1681/ASN.2014040332
Disease Control and Prevention Chronic Kidney Disease Surveillance Team ; Powe, Neil R. / High dietary acid load predicts ESRD among adults with CKD. In: Journal of the American Society of Nephrology. 2015 ; Vol. 26, No. 7. pp. 1693-1700.
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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,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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