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Renal biomarkers of acid excretion capacity: relationships with body fatness and blood pressure

European Journal of Clinical Nutrition volume 74, pages 76–82 (2020)Cite this article

Abstract

Background

Overweight and higher BMI are known to be related to increased blood pressure (BP) and additionally associate with lowered urine pH values even at comparable total daily acid loading. Since a reduced urine pH level at a given total acid load indicates an impaired renal net acid excretion capacity (NAEC) and renal function also relates to BP, we hypothesized that NAEC may be one mediator of the body fat–BP association.

Methods

Ammonium, titratable acid, pH, creatinine, and urea were measured in 24-h urine samples among 9–15-year-old adolescents of the DONALD Study. NAEC was determined as residual of the body surface area-corrected net acid excretion on urine pH (NAEC1) or body surface area-corrected ammonium excretion on urine pH (NAEC2). Markers of body fatness were determined anthropometrically and systolic and diastolic BP sphygmomanometrically. Multilinear regressions were used to examine cross-sectionally the body fat–NAEC and prospectively the NAEC1–BP associations.

Results

All body fat parameters were inversely associated with both NAEC1 and NAEC2 among youth (P ≤ 0.01). In a separate prospective analyses, to check for possible mediation, higher adolescent NAEC1 was significantly associated with lower systolic BP in male adults only (P = 0.04), but this association was attenuated to a trend (P = 0.07) in multivariable-adjusted models.

Conclusions

Independent of systemic acid load, NAEC, i.e., the kidney’s function to eliminate acids is reduced with higher body fatness, and may also contribute as a mediator in the body fatness–BP relation.

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Fig. 1: Relationship of NAE and 24-h urine pH.
Fig. 2: Means of acid excretion capacity indices in tertiles of body fat measures.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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Acknowledgements

We thank our colleagues in the DONALD laboratory, and the anthropometric and dietary section for their dedicated technical assistance and performing all the detailed measurements. Particular thanks deserve our DONALD participants without whom such examinations in healthy free-living subjects during growth and later adulthood would never be possible.

Funding

The DONALD Study is funded by the Ministry of Innovation, Science and Research of North Rhine-Westphalia, Germany. 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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Author notes

  1. These authors contributed equally: Danika Krupp, Yifan Hua

Authors and Affiliations

  1. DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study Center, Department of Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Dortmund, Germany

    Danika Krupp, Yifan Hua, Jonas Esche & Thomas Remer

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  1. Danika Krupp
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  2. Yifan Hua
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  3. Jonas Esche
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  4. Thomas Remer
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Contributions

All authors contributed to the designing of the research; DK and YH were responsible for statistical analyses and together with T.R. and JE for interpretation of the results. DK and YH were responsible for writing the paper together with TR; TR and DK have primary responsibility for the final content. All authors were involved in revising the paper critically and approved the final version.

Corresponding author

Correspondence to Thomas Remer.

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Conflict of interest

JE has received consulting fees from Nutricia North America, Inc. Remaining authors declare no conflict of interest.

Ethics

Ethical approval was obtained from the Ethics Committee of the University of Bonn, Germany. All assessments were performed with parental and grown-up children’s consent.

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Krupp, D., Hua, Y., Esche, J. et al. Renal biomarkers of acid excretion capacity: relationships with body fatness and blood pressure. Eur J Clin Nutr 74 (Suppl 1), 76–82 (2020). https://doi.org/10.1038/s41430-020-0696-2

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