Dietary Acid Load and Relationship with Albuminuria and Glomerular Filtration Rate in Individuals with Chronic Kidney Disease at Predialysis State

The Western diet, characterized by excessive consumption of animal protein and reduced intake of vegetables and fruits, is also rich in sulfur, chlorine, and organic acids, which are the main sources of dietary acid load. A relationship between dietary acid load, renal function, and progression of chronic kidney disease has been demonstrated. Dietary modifications seem to contribute to a reduction in dietary acid load, and are associated with improved outcomes in individuals with chronic kidney disease (CKD). The aim of this paper was to review the existing evidence concerning the association between dietary acid load and renal function in nondialyzed individuals with CKD. A systematic review was conducted by gathering articles in electronic databases (MEDLINE/PubMed, Scopus, and Web of Science) from January 2018 to May 2021. Dietary acid load and GFR and/or albuminuria were analyzed. A total of 1078 articles were extracted, of which 5 met the inclusion criteria. Only one study found no statistically significant associations between the study variables. The remaining showed a negative association between dietary acid load and renal function. This systematic review confirmed the existence of an association between dietary acid load and renal function, with a high dietary acid load contributing to a decreased renal function.

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The Serum Metabolome Identifies Biomarkers of Dietary Acid Load in 2 Studies of Adults with Chronic Kidney Disease

Journal of Nutrition ◽

10.1093/jn/nxy311 ◽

2019 ◽

Vol 149 (4) ◽

pp. 578-585 ◽

Cited By ~ 6

Author(s):

Casey M Rebholz ◽

Aditya Surapaneni ◽

Andrew S Levey ◽

Mark J Sarnak ◽

Lesley A Inker ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Fruits And Vegetables ◽

Smoking Status ◽

Cross Sectional ◽

Dietary Acid Load ◽

Nutrition Research ◽

Net Endogenous Acid Production ◽

Dietary Acid ◽

Acid Load

ABSTRACT Background Dietary acid load is a clinically important aspect of the diet that reflects the balance between acid-producing foods, for example, meat and cheese, and base-producing foods, for example, fruits and vegetables. Methods We used metabolomics to identify blood biomarkers of dietary acid load in 2 independent studies of chronic kidney disease patients: the African American Study of Kidney Disease and Hypertension (AASK, n = 689) and the Modification of Diet in Renal Disease (MDRD, n = 356) study. Multivariable linear regression was used to assess the cross-sectional association between serum metabolites whose identity was known (outcome) and dietary acid load (exposure), estimated with net endogenous acid production (NEAP) based on 24-h urine urea nitrogen and potassium, and adjusted for age, sex, race, randomization group, measured glomerular filtration rate, log-transformed urine protein-to-creatinine ratio, history of cardiovascular disease, BMI, and smoking status. Results Out of the 757 known, nondrug metabolites identified in AASK, 26 were significantly associated with NEAP at the Bonferroni threshold for significance (P < 6.6 × 10−5). Twenty-three of the 26 metabolites were also identified in the MDRD study, and 13 of the 23 (57%) were significantly associated with NEAP (P < 2.2 × 10−3), including 5 amino acids (S-methylmethionine, indolepropionylglycine, indolepropionate, N-methylproline, N-δ-acetylornithine), 2 cofactors and vitamins (threonate, oxalate), 1 lipid (chiro-inositol), and 5 xenobiotics (methyl glucopyranoside, stachydrine, catechol sulfate, hippurate, and tartronate). Higher levels of all 13 replicated metabolites were associated with lower NEAP in both AASK and the MDRD study. Conclusion Metabolomic profiling of serum specimens from kidney disease patients in 2 study populations identified 13 replicated metabolites associated with dietary acid load. Additional studies are needed to validate these compounds in healthy populations. These 13 compounds may potentially be used as objective markers of dietary acid load in future nutrition research studies.

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Association of dietary acid load with serum bicarbonate in chronic kidney disease (CKD) patients

European Journal of Clinical Nutrition ◽

10.1038/s41430-020-0689-1 ◽

2020 ◽

Vol 74 (S1) ◽

pp. 69-75

Author(s):

Larissa Rodrigues Neto Angeloco ◽

Gabriela Cristina Arces de Souza ◽

Elen Almeida Romão ◽

Lynda Frassetto ◽

Paula Garcia Chiarello

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Bicarbonate ◽

Dietary Acid Load ◽

Dietary Acid ◽

Acid Load

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Dietary Acid Load: Implications in the Metabolic Acidosis of Patients with Chronic Kidney Disease.

Journal of Renal Nutrition ◽

10.1053/j.jrn.2015.01.004 ◽

2015 ◽

Vol 25 (2) ◽

pp. 140

Keyword(s):

Chronic Kidney Disease ◽

Metabolic Acidosis ◽

Kidney Disease ◽

Dietary Acid Load ◽

Dietary Acid ◽

Acid Load

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Dietary acid load and chronic kidney disease in elderly adults: Protein and potassium intake

PLoS ONE ◽

10.1371/journal.pone.0185069 ◽

2017 ◽

Vol 12 (9) ◽

pp. e0185069 ◽

Cited By ~ 15

Author(s):

Byung-Joon Ko ◽

Yoosoo Chang ◽

Seungho Ryu ◽

Eun Mi Kim ◽

Mi Yeon Lee ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Adults ◽

Dietary Acid Load ◽

Potassium Intake ◽

Dietary Acid ◽

Acid Load

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Higher estimated net endogenous acid production with lower intake of fruits and vegetables based on a dietary survey is associated with the progression of chronic kidney disease

BMC Nephrology ◽

10.1186/s12882-019-1591-8 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Koji Toba ◽

Michihiro Hosojima ◽

Hideyuki Kabasawa ◽

Shoji Kuwahara ◽

Toshiko Murayama ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Acid Production ◽

Protein Intake ◽

Fruits And Vegetables ◽

Ckd Progression ◽

Dietary Acid Load ◽

Net Endogenous Acid Production ◽

Dietary Acid ◽

Acid Load

Abstract Background Dietary acid load has been suggested to mediate the progression of chronic kidney disease (CKD). However, it is unclear what kinds of foods are actually associated with dietary acid load in patients with CKD. The self-administered diet history questionnaire (DHQ), which semi-quantitatively assesses the dietary habits of Japanese individuals through 150 question items, can estimate average daily intake of various foods and nutrients during the previous month. Using the DHQ, we investigated the association of dietary acid load with CKD progression. We also analyzed the kinds of food that significantly affect dietary acid load. Methods Subjects were 96 outpatients with CKD (average estimated glomerular filtration rate [eGFR], 53.0 ± 18.1 ml/min/1.73 m2) at Niigata University Hospital, who had completed the DHQ in 2011. We calculated net endogenous acid production (NEAP) from potassium and protein intake evaluated by the DHQ in order to assess dietary acid load. CKD progression was assessed by comparing eGFR between 2008 and 2014. Results NEAP was not correlated with protein intake (r = 0.088, p = 0.398), but was negatively correlated with potassium intake (r = − 0.748, p < 0.001). Reduction in eGFR from 2008 to 2014 was estimated to be significantly greater in patients with higher NEAP (NEAP > 50.1 mEq/day, n = 45) than in those with lower NEAP (NEAP ≤50.1 mEq/day, n = 50) by 5.9 (95% confidence interval [95%CI], 0.1 to 11.6) ml/min/1.73 m2. According to multiple logistic regression analysis, higher NEAP was significantly associated with lower intake of fruits (odds ratio [OR], 6.454; 95%CI, 2.19 to 19.00), green and yellow vegetables (OR, 5.18; 95%CI, 1.83 to14.66), and other vegetables (OR, 3.87; 95%CI, 1.29 to 11.62). Conclusions Elevated NEAP could be a risk factor for CKD progression. Low intake of fruits and vegetables would increase dietary acid load and might affect the progression of renal dysfunction in Japanese CKD patients.

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High Dietary Acid Load and Progression to ESRD Among Chronic Kidney Disease (CKD) Patients

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2013.02.036 ◽

2013 ◽

Vol 61 (4) ◽

pp. B23

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Dietary Acid Load ◽

Dietary Acid ◽

Acid Load

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Dietary acid load, kidney function and risk of Chronic Kidney Disease: A Systematic Review and Meta-analysis of Observational Studies

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000584 ◽

2019 ◽

pp. 1-13 ◽

Cited By ~ 2

Author(s):

Manije Darooghegi Mofrad ◽

Elnaz Daneshzad ◽

Leila Azadbakht

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Observational Studies ◽

Meta Analysis ◽

Inverse Association ◽

Urine Ph ◽

Dietary Acid Load ◽

Dietary Acid ◽

Acid Load

Abstract. Aim: Study findings examining the association between dietary acid load (DAL), kidney function and risk of chronic kidney disease (CKD) are inconsistent and there has been no meta-analysis on the relationship between DAL, kidney function and risk of CKD, hence we investigated this association in this paper. Methods: PubMed, ISI web of science and Scopus were searched up to January 2018 to identify all relevant articles. Effect sizes of eligible studies were pooled in random- effect model using the Der Simonian-Laird method. The I2 index was used to assess the amount of heterogeneity. Result: Twenty three studies with 200092 subjects were included. Meta-analysis of 9 observational studies showed that DAL had a positive significant association with risk of CKD (1.31; 95% CI: 1.06, 1.62; P = 0.011). Furthermore, increased DAL can decrease urine pH (−0.47; 95% CI: −0.85, −0.08; P = 0.017) significantly. Subgroup analysis could not identify the sources of heterogeneity about the association of DAL and risk of CKD. However, it showed the method of measurement was the source of heterogeneity about the association of DAL and urine pH (24 h urine pH: −0.62; 95% CI: −0.70, −0.54; P < 0.0001; Fasting urine pH: −0.08; 95% CI: −0.18, 0.02; P = 0.111). Conclusion: Our study showed that DAL can increase the risk of CKD and have an inverse association with urine pH.

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