Journal
KIDNEY INTERNATIONAL
Volume 82, Issue 1, Pages 106-112Publisher
ELSEVIER SCIENCE INC
DOI: 10.1038/ki.2012.82
Keywords
AASK (African American Study of Kidney Disease and Hypertension); acidosis; chronic kidney disease; nutrition
Categories
Funding
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- National Center on Minority Health and Health Disparities, NCMHD
- National Institutes of Health [M01 RR-00080, M01 RR-00071, M0100032, P20-RR11145, M01 RR00827, M01 RR00052, 2P20 RR11104, RR029887, DK 2818-02]
- National Institute of Diabetes and Digestive and Kidney Diseases [T32 DK 00732-14, R21DK078218]
- National Center for Research Resources, a component of the NIH [5KL2RR025006]
- NIH Roadmap for Medical Research
- National Kidney Foundation of Maryland
- National Institute of Diabetes, Digestive and Kidney Diseases [5R01DK072367-03]
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Heart Lung and Blood Institute [K01 HL092595-02]
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Increased acid excretion may promote renal injury. To evaluate this in African Americans with hypertensive nephrosclerosis, we studied the association between the net endogenous acid production and progression of kidney disease in 632 patients in the AASK trial. Protein and potassium intakes were estimated from 24 h urea nitrogen and potassium excretion, and used to estimate net endogenous acid production, averaged over 2 years, approximating routine intake. The link between net endogenous acid production and the I(125)iothalamate glomerular filtration rate (iGFR) and time to end-stage renal disease or doubling of serum creatinine was analyzed using mixed models and Cox proportional hazards regressions. The trend in higher net endogenous acid production was significantly associated with a faster decline in iGFR over a median of 3.2 years. After adjustment for age, body mass index, baseline iGFR, urine protein-to-creatinine ratio, and randomized treatment group, the trend in higher net endogenous acid production remained significantly associated with a faster decline in iGFR at a rate of 1.01ml/min per 1.73m(2) per year faster in the highest compared to the lowest quartile. However, in time-to-event analyses over a median of 7.7 years, the adjusted hazard ratio (1.10) for composite renal events per 25mEq/day higher net endogenous acid production was not significant. Hence, our findings implicate endogenous acid production as a potential modifiable risk factor for progressive kidney disease. Kidney International (2012) 82, 106-112; doi:10.1038/ki.2012.82; published online 4 April 2012
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