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Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes.

Publication ,  Journal Article
Scialla, JJ; Asplin, J; Dobre, M; Chang, AR; Lash, J; Hsu, C-Y; Kallem, RR; Hamm, LL; Feldman, HI; Chen, J; Appel, LJ; Anderson, CAM; Wolf, M ...
Published in: Kidney Int
January 2017

Higher diet-dependent nonvolatile acid load is associated with faster chronic kidney disease (CKD) progression, but most studies have used estimated acid load or measured only components of the gold standard, net acid excretion (NAE). Here we measured NAE as the sum of urine ammonium and titratable acidity in 24-hour urines from a random subset of 980 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. In multivariable models accounting for demographics, comorbidity and kidney function, higher NAE was significantly associated with lower serum bicarbonate (0.17 mEq/l lower serum bicarbonate per 10 mEq/day higher NAE), consistent with a larger acid load. Over a median of 6 years of follow-up, higher NAE was independently associated with a significantly lower risk of the composite of end-stage renal disease or halving of estimated glomerular filtration rate among diabetics (hazard ratio 0.88 per 10 mEq/day higher NAE), but not those without diabetes (hazard ratio 1.04 per 10 mEq/day higher NAE). For comparison, we estimated the nonvolatile acid load as net endogenous acid production using self-reported food frequency questionnaires from 2848 patients and dietary urine biomarkers from 3385 patients. Higher net endogenous acid production based on biomarkers (urea nitrogen and potassium) was modestly associated with faster CKD progression consistent with prior reports, but only among those without diabetes. Results from the food frequency questionnaires were not associated with CKD progression in any group. Thus, disparate results obtained from analyses of nonvolatile acid load directly measured as NAE and estimated from diet suggest a novel hypothesis that the risk of CKD progression related to low NAE or acid load may be due to diet-independent changes in acid production in diabetes.

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Published In

Kidney Int

DOI

EISSN

1523-1755

Publication Date

January 2017

Volume

91

Issue

1

Start / End Page

204 / 215

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Surveys and Questionnaires
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Renal Elimination
  • Proportional Hazards Models
  • Potassium
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Scialla, J. J., Asplin, J., Dobre, M., Chang, A. R., Lash, J., Hsu, C.-Y., … Chronic Renal Insufficiency Cohort Study Investigators, . (2017). Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes. Kidney Int, 91(1), 204–215. https://doi.org/10.1016/j.kint.2016.09.012
Scialla, Julia J., John Asplin, Mirela Dobre, Alex R. Chang, James Lash, Chi-Yuan Hsu, Radhakrishna R. Kallem, et al. “Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes.Kidney Int 91, no. 1 (January 2017): 204–15. https://doi.org/10.1016/j.kint.2016.09.012.
Scialla JJ, Asplin J, Dobre M, Chang AR, Lash J, Hsu C-Y, et al. Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes. Kidney Int. 2017 Jan;91(1):204–15.
Scialla, Julia J., et al. “Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes.Kidney Int, vol. 91, no. 1, Jan. 2017, pp. 204–15. Pubmed, doi:10.1016/j.kint.2016.09.012.
Scialla JJ, Asplin J, Dobre M, Chang AR, Lash J, Hsu C-Y, Kallem RR, Hamm LL, Feldman HI, Chen J, Appel LJ, Anderson CAM, Wolf M, Chronic Renal Insufficiency Cohort Study Investigators. Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes. Kidney Int. 2017 Jan;91(1):204–215.
Journal cover image

Published In

Kidney Int

DOI

EISSN

1523-1755

Publication Date

January 2017

Volume

91

Issue

1

Start / End Page

204 / 215

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Surveys and Questionnaires
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Renal Elimination
  • Proportional Hazards Models
  • Potassium
  • Middle Aged
  • Male
  • Humans