Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes.
Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes.
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DOI：
10.1016/j.kint.2016.09.012
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发表时间：
2017-01
影响因子：
19.6
通讯作者：
Chronic Renal Insufficiency Cohort Study Investigators
中科院分区：
文献类型：
--
作者：
Scialla JJ;Asplin J;Dobre M;Chang AR;Lash J;Hsu CY;Kallem RR;Hamm LL;Feldman HI;Chen J;Appel LJ;Anderson CA;Wolf M;Chronic Renal Insufficiency Cohort Study Investigators
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 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 nonvolatile acid load as net endogenous acid production using self-reported food frequency questionnaires from 2,848 patients and dietary urine biomarkers from 3,385 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, suggests 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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影响因子：
13.6
作者：
de Brito-Ashurst, Ione;Varagunam, Mira;Yaqoob, Muhammad M.
通讯作者：
Yaqoob, Muhammad M.
影响因子：
--
作者：
JENKINS, AD;DOUSA, TP;SMITH, LH
通讯作者：
SMITH, LH
影响因子：
13.6
作者：
Banerjee, Tanushree;Crews, Deidra C.;Powe, Neil R.
通讯作者：
Powe, Neil R.
影响因子：
82.9
作者：
通讯作者：
--
DOI：
10.2215/cjn.00070109
发表时间：
2009-08-01
影响因子：
9.8
作者：
Lash, James P.;Go, Alan S.;Feldman, Harold I.
通讯作者：
Feldman, Harold I.