High Dietary Acid Load Predicts ESRD among Adults with CKD
High Dietary Acid Load Predicts ESRD among Adults with CKD
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DOI：
10.1681/asn.2014040332
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发表时间：
2015-07-01
影响因子：
13.6
通讯作者：
Powe, Neil R.
中科院分区：
文献类型：
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作者：
Banerjee, Tanushree;Crews, Deidra C.;Powe, Neil R.
小型临床试验表明，减少膳食酸负荷（DAL）可改善肾损伤并减缓肾功能下降;然而，在基于人群的CKD队列中，DAL与ESRD风险之间的关系尚未得到研究。我们在美国全国代表性成人样本中研究了通过净酸排泄（NAE（es））量化的DAL与进展为ESRD之间的相关性。在1486名20岁的CKD成年人中，通过24小时饮食回忆问卷调查确定了DAL。通过与Medicare ESRD登记处的联系，在中位14.2年的随访中确定了ESRD的发展。在调整人口统计学、营养因素、临床因素和肾功能/损伤标志物并考虑干预死亡事件后，我们使用Fine-Gray竞争风险方法估计高、中、低DAL与ESRD的相关性。共有311名（20.9%）参与者发展为ESRD。较高水平的DAL与ESRD风险增加相关;在完全校正模型中，与最低三分位数相比，最高三分位数的相对风险（95%置信区间）为3.04（1.58至5.86），中间三分位数为1.81（0.89至3.68）。与DAL三分位数相关的ESRD风险随着eGFR降低而增加（P趋势=0.001）。在蛋白尿患者中，高DAL与ESRD风险密切相关（P趋势=0.03）。总之，在全国代表性人群中，CKD患者的高DAL与ESRD风险增加独立相关。
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 (NAE(es)), and progression to ESRD in a nationally representative sample of adults in the United States. Among 1486 adults with CKD age20 years enrolled in the National Health and Nutrition Examination Survey III, DAL was determined by 24-h dietary recall questionnaire. The development of ESRD was 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 the middle 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.