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Dietary acid load and the risk of events of mortality and kidney replacement therapy in people with chronic kidney disease: the Progredir Cohort Study

European Journal of Clinical Nutrition volume 78, pages 128–134 (2024)Cite this article

Subjects

Abstract

Background/Objectives

The association between dietary acid load (DAL) and chronic kidney disease (CKD) progression remains controversial. Also, there is a gap in the literature on the association between DAL and mortality. In this study, we evaluated the association between NEAP (net endogenous acid production) and PRAL (potential renal acid load) and the risk of events of all-cause mortality and kidney replacement therapy (KRT) in people with CKD.

Subjects/Methods

We included 442 patients (250 diabetics) from the Progredir Cohort Study, based in São Paulo, Brazil. We estimated NEAP and PRAL from dietary intake. Events of death before KRT and KRT were ascertained after a median follow-up of 5.8 and 5.1 years, respectively. Cox proportional hazards regression, Weibull regression, and competing risk models were performed.

Results

Median NEAP and PRAL were 49.5 and 4.8 mEq/d. There were 200 deaths and 75 KRT events. Neither NEAP nor PRAL were associated with mortality or KRT when all participants were analyzed. After stratification for diabetes, both estimates were positively related to the risk of KRT even after adjustment for age, sex, weight status, glomerular filtration rate, serum bicarbonate, and intakes of protein, phosphorus, and energy (HR 1.31; 95% CI 1.07, 1.60 for NEAP, and HR 1.27; 95% CI 1.04, 1.57 for every 10 mEq/d increments). Competing risk analyses confirmed these findings.

Conclusions

DAL estimates were associated with the risk of KRT in people with CKD and diabetes but not in non-diabetics. There was no association between all-cause mortality and DAL.

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Data availability

Data described in the manuscript, code book, and analytic code will be made available upon request pending.

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Funding

The study received funding from the Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) (procedural no. 11/17341-0). ADM received financial support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (procedural no. 88882.327915/2019-01). The Progredir Cohort Study used the structure of the research center for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), in São Paulo, which was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Financiadora de Estudos e Projetos, FINEP; and Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq) (procedural no. 01 06 0115.00 SP).

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Authors and Affiliations

  1. Division of Nephrology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil

    Alisson Diego Machado & Silvia Maria Titan

  2. Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil

    Dirce Maria Marchioni

  3. Epidemiological and Clinical Research Center, University Hospital of the University of São Paulo, São Paulo, SP, Brazil

    Paulo Andrade Lotufo & Isabela Martins Benseñor

  4. Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA

    Silvia Maria Titan

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  1. Alisson Diego Machado
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  2. Dirce Maria Marchioni
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  3. Paulo Andrade Lotufo
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  4. Isabela Martins Benseñor
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Contributions

ADM, PAL, IMB, and SMT designed and conducted research; ADM, DMM, and SMT provided data curation; PAL and IMB provided essential materials; ADM performed statistical analysis; ADM and SMT wrote the paper and had primary responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to Alisson Diego Machado.

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The authors declare no competing interests.

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The Progredir Cohort Study was approved by two Brazilian Ethics Committees (protocols 11147/11 and 0798/11), and all participants provided written informed consent.

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Machado, A.D., Marchioni, D.M., Lotufo, P.A. et al. Dietary acid load and the risk of events of mortality and kidney replacement therapy in people with chronic kidney disease: the Progredir Cohort Study. Eur J Clin Nutr 78, 128–134 (2024). https://doi.org/10.1038/s41430-023-01361-0

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