Tags

Type your tag names separated by a space and hit enter

Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease.
J Ren Nutr. 2016 Mar; 26(2):93-102.JR

Abstract

OBJECTIVE

In chronic kidney disease (CKD), dietary acid may promote metabolic acidosis and insulin resistance, which in turn may contribute to adverse clinical health outcomes. We examined associations between dietary acid load, serum bicarbonate, and insulin sensitivity in CKD.

DESIGN

In a cross-sectional study, we collected 3-day prospective food diaries to quantify dietary acid load as net endogenous acid production (NEAP, the nonvolatile acid load produced by the diet's acid balance) and potential renal acid load (PRAL). We measured urine net acid excretion (NAE) in 24-hour urine samples. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp.

SUBJECTS

Forty-two patients with CKD Stages 3 to 5 attending nephrology clinics in the Pacific Northwest and 21 control subjects (estimated glomerular filtration rate [eGFR] ≥ 60 mL/minute/1.73 m(2)).

MAIN OUTCOME MEASURES

Serum bicarbonate and insulin sensitivity (SIclamp).

RESULTS

Mean age was 60.8 ± 13.6 years, and 54% of participants were men. Mean eGFR and serum bicarbonate concentrations were 34.4 ± 13.1 mL/minute/1.73 m(2) and 24.1 ± 2.9 mEq/L for participants with CKD and 88.6 ± 14.5 mL/minute/1.73 m(2) and 26.3 ± 1.8 mEq/L for control subjects, respectively. Mean NEAP, PRAL, and NAE were 58.2 ± 24.3, 9.7 ± 18.4, and 32.1 ± 19.8 mEq/day, respectively. Considering all participants, dietary acid load was significantly, inversely associated with serum bicarbonate, adjusting for age, gender, race, eGFR, body mass index, and diuretic use: -1.2 mEq/L per standard deviation (SD) NEAP (95% confidence interval [CI] -1.8 to -0.6, P < .0001); -0.9 mEq/L bicarbonate per SD PRAL (95% CI -1.5 to -0.4, P = .0005); -0.7 mEq/L bicarbonate per SD NAE (95% CI -1.2 to -0.1, P = .01). These associations were similar in participants with and without CKD. However, neither NEAP and PRAL nor NAE was significantly associated with SIclamp. Serum bicarbonate was also not significantly associated with SIclamp.

CONCLUSIONS

In CKD, dietary acid load is associated with serum bicarbonate, suggesting that acidosis may be improved by dietary changes, but not with insulin sensitivity.

Authors+Show Affiliations

University of Vermont College of Medicine, Burlington, Vermont; Kidney Research Institute, University of Washington, Seattle, Washington.Kidney Research Institute, University of Washington, Seattle, Washington.Kidney Research Institute, University of Washington, Seattle, Washington.Kidney Research Institute, University of Washington, Seattle, Washington.Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington.Kidney Research Institute, University of Washington, Seattle, Washington; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.Kidney Research Institute, University of Washington, Seattle, Washington; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.Kidney Research Institute, University of Washington, Seattle, Washington; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington. Electronic address: deboer@u.washington.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26508542

Citation

Ikizler, Halil O., et al. "Dietary Acid Load Is Associated With Serum Bicarbonate but Not Insulin Sensitivity in Chronic Kidney Disease." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 26, no. 2, 2016, pp. 93-102.
Ikizler HO, Zelnick L, Ruzinski J, et al. Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease. J Ren Nutr. 2016;26(2):93-102.
Ikizler, H. O., Zelnick, L., Ruzinski, J., Curtin, L., Utzschneider, K. M., Kestenbaum, B., Himmelfarb, J., & de Boer, I. H. (2016). Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 26(2), 93-102. https://doi.org/10.1053/j.jrn.2015.08.008
Ikizler HO, et al. Dietary Acid Load Is Associated With Serum Bicarbonate but Not Insulin Sensitivity in Chronic Kidney Disease. J Ren Nutr. 2016;26(2):93-102. PubMed PMID: 26508542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease. AU - Ikizler,Halil O, AU - Zelnick,Leila, AU - Ruzinski,John, AU - Curtin,Laura, AU - Utzschneider,Kristina M, AU - Kestenbaum,Bryan, AU - Himmelfarb,Jonathan, AU - de Boer,Ian H, Y1 - 2015/10/23/ PY - 2015/05/22/received PY - 2015/08/05/revised PY - 2015/08/16/accepted PY - 2017/03/01/pmc-release PY - 2015/10/29/entrez PY - 2015/10/29/pubmed PY - 2016/12/15/medline SP - 93 EP - 102 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 26 IS - 2 N2 - OBJECTIVE: In chronic kidney disease (CKD), dietary acid may promote metabolic acidosis and insulin resistance, which in turn may contribute to adverse clinical health outcomes. We examined associations between dietary acid load, serum bicarbonate, and insulin sensitivity in CKD. DESIGN: In a cross-sectional study, we collected 3-day prospective food diaries to quantify dietary acid load as net endogenous acid production (NEAP, the nonvolatile acid load produced by the diet's acid balance) and potential renal acid load (PRAL). We measured urine net acid excretion (NAE) in 24-hour urine samples. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp. SUBJECTS: Forty-two patients with CKD Stages 3 to 5 attending nephrology clinics in the Pacific Northwest and 21 control subjects (estimated glomerular filtration rate [eGFR] ≥ 60 mL/minute/1.73 m(2)). MAIN OUTCOME MEASURES: Serum bicarbonate and insulin sensitivity (SIclamp). RESULTS: Mean age was 60.8 ± 13.6 years, and 54% of participants were men. Mean eGFR and serum bicarbonate concentrations were 34.4 ± 13.1 mL/minute/1.73 m(2) and 24.1 ± 2.9 mEq/L for participants with CKD and 88.6 ± 14.5 mL/minute/1.73 m(2) and 26.3 ± 1.8 mEq/L for control subjects, respectively. Mean NEAP, PRAL, and NAE were 58.2 ± 24.3, 9.7 ± 18.4, and 32.1 ± 19.8 mEq/day, respectively. Considering all participants, dietary acid load was significantly, inversely associated with serum bicarbonate, adjusting for age, gender, race, eGFR, body mass index, and diuretic use: -1.2 mEq/L per standard deviation (SD) NEAP (95% confidence interval [CI] -1.8 to -0.6, P < .0001); -0.9 mEq/L bicarbonate per SD PRAL (95% CI -1.5 to -0.4, P = .0005); -0.7 mEq/L bicarbonate per SD NAE (95% CI -1.2 to -0.1, P = .01). These associations were similar in participants with and without CKD. However, neither NEAP and PRAL nor NAE was significantly associated with SIclamp. Serum bicarbonate was also not significantly associated with SIclamp. CONCLUSIONS: In CKD, dietary acid load is associated with serum bicarbonate, suggesting that acidosis may be improved by dietary changes, but not with insulin sensitivity. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/26508542/Dietary_Acid_Load_is_Associated_With_Serum_Bicarbonate_but_not_Insulin_Sensitivity_in_Chronic_Kidney_Disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(15)00154-5 DB - PRIME DP - Unbound Medicine ER -