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Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease.
Clin J Am Soc Nephrol. 2011 Jul; 6(7):1526-32.CJ

Abstract

BACKGROUND AND OBJECTIVES

Metabolic acidosis may contribute to morbidity and disease progression in patients with chronic kidney disease (CKD). The ratio of dietary protein, the major source of nonvolatile acid, to dietary potassium, which is naturally bound to alkali precursors, can be used to estimate net endogenous acid production (NEAP). We tested the association between estimated NEAP and serum bicarbonate in patients with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

NEAP was estimated among 462 African American adults with hypertensive CKD using published equations: NEAP (mEq/d) = -10.2 + 54.5 (protein [g/d]/potassium [mEq/d]). Dietary protein and potassium intake were estimated from 24-hour urinary excretion of urea nitrogen and potassium, respectively. All of the eligible measurements during follow-up were modeled using generalized linear regression clustered by participant and adjusted for demographics, 24-hour urinary sodium, kidney function, and selected medications.

RESULTS

Higher NEAP was associated with lower serum bicarbonate in a graded fashion (P trend < 0.001). Serum bicarbonate was 1.27 mEq/L lower among those in the highest compared with the lowest quartile of NEAP (P < 0.001). There was a greater difference in serum bicarbonate between the highest and lowest quartiles of NEAP among patients with stage 4/5 CKD (-2.43 mEq/L, P < 0.001) compared with those with stage 2/3 disease (-0.77 mEq/L, P = 0.01; P-interaction = 0.02).

CONCLUSIONS

Reducing NEAP, through reduction of dietary protein and increased intake of fruits and vegetables, may prevent metabolic acidosis in patients with CKD.

Authors+Show Affiliations

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. jsciall1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21700817

Citation

Scialla, Julia J., et al. "Estimated Net Endogenous Acid Production and Serum Bicarbonate in African Americans With Chronic Kidney Disease." Clinical Journal of the American Society of Nephrology : CJASN, vol. 6, no. 7, 2011, pp. 1526-32.
Scialla JJ, Appel LJ, Astor BC, et al. Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(7):1526-32.
Scialla, J. J., Appel, L. J., Astor, B. C., Miller, E. R., Beddhu, S., Woodward, M., Parekh, R. S., & Anderson, C. A. (2011). Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. Clinical Journal of the American Society of Nephrology : CJASN, 6(7), 1526-32. https://doi.org/10.2215/CJN.00150111
Scialla JJ, et al. Estimated Net Endogenous Acid Production and Serum Bicarbonate in African Americans With Chronic Kidney Disease. Clin J Am Soc Nephrol. 2011;6(7):1526-32. PubMed PMID: 21700817.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. AU - Scialla,Julia J, AU - Appel,Lawrence J, AU - Astor,Brad C, AU - Miller,Edgar R,3rd AU - Beddhu,Srinivasan, AU - Woodward,Mark, AU - Parekh,Rulan S, AU - Anderson,Cheryl A M, Y1 - 2011/06/23/ PY - 2011/6/25/entrez PY - 2011/6/28/pubmed PY - 2011/11/9/medline SP - 1526 EP - 32 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 6 IS - 7 N2 - BACKGROUND AND OBJECTIVES: Metabolic acidosis may contribute to morbidity and disease progression in patients with chronic kidney disease (CKD). The ratio of dietary protein, the major source of nonvolatile acid, to dietary potassium, which is naturally bound to alkali precursors, can be used to estimate net endogenous acid production (NEAP). We tested the association between estimated NEAP and serum bicarbonate in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: NEAP was estimated among 462 African American adults with hypertensive CKD using published equations: NEAP (mEq/d) = -10.2 + 54.5 (protein [g/d]/potassium [mEq/d]). Dietary protein and potassium intake were estimated from 24-hour urinary excretion of urea nitrogen and potassium, respectively. All of the eligible measurements during follow-up were modeled using generalized linear regression clustered by participant and adjusted for demographics, 24-hour urinary sodium, kidney function, and selected medications. RESULTS: Higher NEAP was associated with lower serum bicarbonate in a graded fashion (P trend < 0.001). Serum bicarbonate was 1.27 mEq/L lower among those in the highest compared with the lowest quartile of NEAP (P < 0.001). There was a greater difference in serum bicarbonate between the highest and lowest quartiles of NEAP among patients with stage 4/5 CKD (-2.43 mEq/L, P < 0.001) compared with those with stage 2/3 disease (-0.77 mEq/L, P = 0.01; P-interaction = 0.02). CONCLUSIONS: Reducing NEAP, through reduction of dietary protein and increased intake of fruits and vegetables, may prevent metabolic acidosis in patients with CKD. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/21700817/Estimated_net_endogenous_acid_production_and_serum_bicarbonate_in_African_Americans_with_chronic_kidney_disease_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=21700817 DB - PRIME DP - Unbound Medicine ER -