Dietary acid load in children with chronic kidney disease



Western diet is characterized by a high acid load that could generate various degrees of metabolic acidosis, of which at least the stronger forms are known to contribute to the progression of chronic kidney disease (CKD). The aim of this study was to estimate the potential renal acid load (PRAL) and acid base status in CKD patients attended at the Children’s Hospital J.M. de los Ríos in Caracas, Venezuela from April 2015 to February 2016.


Twenty-seven children with CKD were included. Diet composition was evaluated by a food frequency questionnaire and a 24-h intake reminder. PRAL was calculated by the Remer and Manz method. Laboratory tests included serum creatinine, electrolytes and venous gases.


Protein intake was above recommendations in 21 patients (78.6%). Average vegetable and fruit intake was 0.4 and 1.5 servings per day, respectively. Mean PRAL was 16 ± 10.7 mEq/day. PRAL correlated positively with energy (p = 0.005), protein (p = 0.001) and fat intake (p = 0.0001), daily servings of dairy (p = 0.04) meat (p = 0.001) and cereals (0.001) and negatively with vegetable intake (p = 0.04). Serum pH and bicarbonate were 7.3 ± 0.08 and 20.46 ± 4.5 mEq/L, respectively. Twenty-one patients (80.7%) with metabolic acidosis were treated with sodium bicarbonate.


Dietary pattern of Venezuelan children with CKD may constitute a risk factor for the progression of the disease by promoting metabolic acidosis via unfavorable dietary acid loads. PRAL should be assessed as a valuable guide for nutritional counseling in children with CKD.

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No financial assistance was received in support of this study. This article is published as part of a supplement sponsored by NuOmix-Research K.S. The conference was financially supported by Protina Pharmazeutische GmbH, Germany and Sirius Pharma, Germany, and organized by NuOmix-Research K.S. Neither company had any role in writing of the paper.

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ML conceived and designed the study, participated in analysis and interpretation of data, and wrote the paper. G Moreno, GL, and G Marcano participated in the acquisition, analysis, and interpretation of data.

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Correspondence to Michelle López.

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The authors declare that they have no conflict of interest.


The study was approved by the institution’s Bioethics Committee. Children’s parents were informed in detail about the objectives of the research. A written consent was obtained from parents or representatives and from children over 8 years of age by means of an informed or assent consent, respectively.

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López, M., Moreno, G., Lugo, G. et al. Dietary acid load in children with chronic kidney disease. Eur J Clin Nutr 74, 57–62 (2020).

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