Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease
Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease
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DOI：
10.1053/j.jrn.2015.08.008
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发表时间：
2016-03-01
影响因子：
3.2
通讯作者：
de Boer, Ian H.
中科院分区：
文献类型：
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作者：
Ikizler, Halil O.;Zelnick, Leila;de Boer, Ian H.
目的：在慢性肾脏病（CKD）中，膳食酸可能会促进代谢性酸中毒和胰岛素抵抗，进而可能导致不良的临床健康结果。我们研究了 CKD 中膳食酸负荷、血清碳酸氢盐和胰岛素敏感性之间的关联。设计：在一项横断面研究中，我们收集了 3 天的前瞻性食物日记，将膳食酸负荷量化为净内源性酸产生量（NEAP，饮食酸平衡产生的非挥发性酸负荷）和潜在肾酸负荷 (PRAL)。我们测量了 24 小时尿液样本中的尿液净酸排泄 (NAE)。通过高胰岛素正常血糖钳夹测量胰岛素敏感性。受试者：在太平洋西北地区肾脏病诊所就诊的 42 名 CKD 3 至 5 期患者和 21 名对照受试者（估计肾小球滤过率 [eGFR] >= 60 mL/分钟/1.73 m(2)）。主要结果指标：血清碳酸氢盐和胰岛素敏感性 (SIclamp)。结果：平均年龄为60.8 +/- 13.6 岁，54% 的参与者是男性。 CKD 受试者的平均 eGFR 和血清碳酸氢盐浓度分别为 34.4 +/- 13.1 mL/min/1.73 m(2) 和 24.1 +/- 2.9 mEq/L，对照受试者的平均 eGFR 和血清碳酸氢盐浓度分别为 88.6 +/- 14.5 mL/min/1.73 m(2) 和 26.3 +/- 1.8 mEq/L。平均 NEAP、PRAL 和 NAE 分别为 58.2 +/- 24.3、9.7 +/- 18.4 和 32.1 +/- 19.8 mEq/天。考虑到所有参与者，膳食酸负荷与血清碳酸氢盐显着呈负相关，调整年龄、性别、种族、eGFR、体重指数和利尿剂使用：每标准差 (SD) NEAP -1.2 mEq/L（95% 置信区间 [CI] -1.8 至 -0.6，P
Objective: In chronic kidney disease (CKD), dietary acid may promote metabolic acidosis and insulin resistance, which in turn may contribute to adverse clinical health outcomes. We examined associations between dietary acid load, serum bicarbonate, and insulin sensitivity in CKD.Design: In a cross-sectional study, we collected 3-day prospective food diaries to quantify dietary acid load as net endogenous acid production (NEAP, the nonvolatile acid load produced by the diet's acid balance) and potential renal acid load (PRAL). We measured urine net acid excretion (NAE) in 24-hour urine samples. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp.Subjects: Forty-two patients with CKD Stages 3 to 5 attending nephrology clinics in the Pacific Northwest and 21 control subjects (estimated glomerular filtration rate [eGFR] >= 60 mL/minute/1.73 m(2)).Main Outcome Measures: Serum bicarbonate and insulin sensitivity (SIclamp).Results: Mean age was 60.8 +/- 13.6 years, and 54% of participants were men. Mean eGFR and serum bicarbonate concentrations were 34.4 +/- 13.1 mL/minute/1.73 m(2) and 24.1 +/- 2.9 mEq/L for participants with CKD and 88.6 +/- 14.5 mL/minute/1.73 m(2) and 26.3 +/- 1.8 mEq/L for control subjects, respectively. Mean NEAP, PRAL, and NAE were 58.2 +/- 24.3, 9.7 +/- 18.4, and 32.1 +/- 19.8 mEq/day, respectively. Considering all participants, dietary acid load was significantly, inversely associated with serum bicarbonate, adjusting for age, gender, race, eGFR, body mass index, and diuretic use: -1.2 mEq/L per standard deviation (SD) NEAP (95% confidence interval [CI] -1.8 to -0.6, P