Race/Ethnicity, Dietary Acid Load, and Risk of End-Stage Renal Disease Among US Adults with Chronic Kidney Disease

Overview

Journal Am J Nephrol

Publisher Karger

Specialty Nephrology

Date 2018 Mar 12

PMID 29525790

Citations 10

Authors

Deidra C Crews

Tanushree Banerjee

Donald E Wesson

Hal Morgenstern

Rajiv Saran

Nilka Rios Burrows

Desmond E Williams

Neil R Powe

Affiliations

Soon will be listed here.

Abstract

Background: Dietary acid load (DAL) contributes to the risk of CKD and CKD progression. We sought to determine the relation of DAL to racial/ethnic differences in the risk of end-stage renal disease (ESRD) among persons with CKD.

Methods: Among 1,123 non-Hispanic black (NHB) and non-Hispanic white (NHW) National Health and Nutrition Examination Survey III participants with estimated glomerular filtration rate 15-59 mL/min/1.73 m2, DAL was estimated using the Remer and Manz net acid excretion (NAEes) formula and 24-h dietary recall. ESRD events were ascertained via linkage with Medicare. A competing risk model (accounting for death) was used to estimate the hazard ratio (HR) for treated ESRD, comparing NHBs with NHWs, adjusting for demographic, clinical and nutritional factors (body surface area, total caloric intake, serum bicarbonate, protein intake), and NAEes. Additionally, whether the relation of NAEes with ESRD risk varied by race/ethnicity was tested.

Results: At baseline, NHBs had greater NAEes (50.9 vs. 44.2 mEq/day) than NHWs. It was found that 22% developed ESRD over a median of 7.5 years. The unadjusted HR comparing NHBs to NHWs was 3.35 (95% CI 2.51-4.48) and adjusted HR (for factors above) was 1.68 (95% CI 1.18-2.38). A stronger association of NAE with risk of ESRD was observed among NHBs (adjusted HR per mEq/day increase in NAE 1.21, 95% CI 1.12-1.31) than that among NHWs (HR 1.08, 95% CI 0.96-1.20), p interaction for race/ethnicity × NAEes = 0.004.

Conclusions: Among US adults with CKD, the association of DAL with progression to ESRD is stronger among NHBs than NHWs. DAL is worthy of further investigation for its contribution to kidney outcomes across race/ethnic groups.

Citing Articles

The Effects of a Whole-Food Plant-Based Nutrition Education Program on Blood Pressure and Potassium in Chronic Kidney Disease: A Proof-of-Concept Study.

Liebman S, Baran A, Barnett T, Campbell T, Chen L, Friedman S Nutrients. 2025; 17(5).

PMID: 40077649 PMC: 11901990. DOI: 10.3390/nu17050779.

Association between Dietary Acid Load and Chronic Kidney Disease in the Chinese Population: A Comprehensive Analysis of the China Health and Nutrition Survey (2009).

Wang S, Fan X, Zheng X, Xia P, Zou H, Zhang Z Nutrients. 2024; 16(15).

PMID: 39125342 PMC: 11314566. DOI: 10.3390/nu16152461.

Health Inequities in the USA: a Role for Dietary Acid Load? Results from the National Health and Nutrition Examination Surveys.

Storz M J Racial Ethn Health Disparities. 2022; 10(6):2851-2860.

PMID: 36422851 PMC: 10645648. DOI: 10.1007/s40615-022-01462-9.

Lifestyle and chronic kidney disease: A machine learning modeling study.

Luo W, Gong L, Chen X, Gao R, Peng B, Wang Y Front Nutr. 2022; 9:918576.

PMID: 35938107 PMC: 9355159. DOI: 10.3389/fnut.2022.918576.

Health inequities and the inappropriate use of race in nephrology.

Eneanya N, Boulware L, Tsai J, Bruce M, Ford C, Harris C Nat Rev Nephrol. 2021; 18(2):84-94.

PMID: 34750551 PMC: 8574929. DOI: 10.1038/s41581-021-00501-8.

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