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Association of dietary acid load with serum bicarbonate in chronic kidney disease (CKD) patients

European Journal of Clinical Nutrition volume 74, pages 69–75 (2020)Cite this article

Abstract

Background/objectives

Diet can affect the acid–base status depending on the balance between the intake of acid-inducing foods and base-inducing foods. The purpose of this study was to estimate the dietary acid load and evaluate its association with serum bicarbonate in patients with stages 3 and 4 chronic kidney disease.

Subjects/methods

One hundred adults (aged ≥ 20 years) with chronic kidney disease (CKD) stages 3 and 4 were enrolled in a cross-sectional study. A food diary was used to estimate the animal and plant protein intakes, which were used in the potential renal acid load (PRAL) formula described by Remer and Manz. PRAL was divided into quartiles. Regression models unadjusted and adjusted for age, gender, body mass index, diabetes, systolic and diastolic blood pressure, creatinine clearance were performed using the stepwise regression method.

Results

The median level (25th, 75th percentiles) of PRAL was 8.3 mEq/day (1.6, 15.6). The highest quartile of PRAL had a higher consumption of animal protein (77.8 ± 10.9%) and a reduced consumption of plant protein (22.2 ± 10.9%), compared to the lowest quartile (59.5 ± 18.6% animal protein, 40.5 ± 18.6% plant protein), p for trend <0.0001. In the adjusted analysis, a significant association was observed between the highest quartile of PRAL and serum bicarbonate in CKD patients compared to the lowest quartile (β: 2.07, 95% CI: 0.21–3.92). According to the multiple linear regression, for each increase of 1 unit of PRAL there was a reduction of 0.25 mmol/L in serum bicarbonate (HCO3). Using the stepwise method, animal protein intake and PRAL were determinants of HCO3 (r = 0.49).

Conclusions

In CKD patients of stages 3 and 4, the dietary acid load was associated with HCO3. Limiting dietary acid load could be a complementary approach in the dietary treatment of CKD. In addition, studies are needed to analyze the effect of replacing animal protein with plant protein.

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Funding

This study was funded by São Paulo Research Foundation, FAPESP, Brazil (2012/19475-6). This article is published as a 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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Authors and Affiliations

  1. Department of Health Science, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil

    Larissa Rodrigues Neto Angeloco, Gabriela Cristina Arces de Souza & Paula Garcia Chiarello

  2. Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil

    Elen Almeida Romão

  3. Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Lynda Frassetto

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  1. Larissa Rodrigues Neto Angeloco
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Correspondence to Larissa Rodrigues Neto Angeloco.

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Angeloco, L.R.N., Arces de Souza, G.C., Romão, E.A. et al. Association of dietary acid load with serum bicarbonate in chronic kidney disease (CKD) patients. Eur J Clin Nutr 74 (Suppl 1), 69–75 (2020). https://doi.org/10.1038/s41430-020-0689-1

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