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Acid retention in chronic kidney disease is inversely related to GFR.
Am J Physiol Renal Physiol. 2018 05 01; 314(5):F985-F991.AJ

Abstract

Greater H+ retention in animal models of chronic kidney disease (CKD) mediates faster glomerular filtration rate (GFR) decline and dietary H+ reduction slows eGFR decline in CKD patients with reduced eGFR and H+ retention due to the high acid (H+) diets of developed societies. We examined if H+ retention in CKD is inversely associated with estimated GFR (eGFR) using cross-sectional and longitudinal analysis of individuals with CKD stage 1 (>90 ml·min- 1·1.73 m-2), CKD stage 2 (60-89 ml/min per 1.73 m2), and CKD stage 3 (30-59 ml·min- 1·1.73 m-2) eGFR. H+ retention was assessed using the difference between observed and expected plasma total CO2 2 h after 0.5 meq/kg body wt oral NaHCO3. H+ retention was higher in CKD 2 vs. CKD 1 (P < 0.01) and in CKD 3 vs. CKD 2 (P < 0.02) at baseline and 5 yr, and was higher in CKD 2 vs. CKD 1 (P < 0.01) at 10 yr. All groups had lower eGFR at subsequent time points (P < 0.01) but H+ retention was not different among the three time points for CKD 1. By contrast, eGFR decrease was associated with higher H+ retention in CKD 2 at 5 yr (P = 0.04) and 10 yr (P < 0.01) and with higher H+ retention in CKD 3 at 5 yr (P < 0.01). Yearly eGFR decline rate was faster in CKD 2 vs. CKD 1 (P < 0.01) and in CKD 3 vs. CKD 2 (P < 0.01). The data show that H+ retention is inversely associated with eGFR, with faster eGFR decline, and support the need for greater dietary H+ reduction therapy for CKD individuals with lower eGFR.

Authors+Show Affiliations

Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas. Department of Internal Medicine, Baylor Scott & White Health, Temple, Texas.Department of Surgery, Texas Tech University Health Sciences Center , Lubbock, Texas.Department of Biostatistics, Baylor Scott & White Health, Temple, Texas.Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern , Dallas, Texas.Department of Internal Medicine, Texas A&M Health Sciences Center College of Medicine , Dallas, Texas. Baylor Scott & White Health and Wellness Center, Dallas, Texas.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29357423

Citation

Goraya, Nimrit, et al. "Acid Retention in Chronic Kidney Disease Is Inversely Related to GFR." American Journal of Physiology. Renal Physiology, vol. 314, no. 5, 2018, pp. F985-F991.
Goraya N, Simoni J, Sager LN, et al. Acid retention in chronic kidney disease is inversely related to GFR. Am J Physiol Renal Physiol. 2018;314(5):F985-F991.
Goraya, N., Simoni, J., Sager, L. N., Pruszynski, J., & Wesson, D. E. (2018). Acid retention in chronic kidney disease is inversely related to GFR. American Journal of Physiology. Renal Physiology, 314(5), F985-F991. https://doi.org/10.1152/ajprenal.00463.2017
Goraya N, et al. Acid Retention in Chronic Kidney Disease Is Inversely Related to GFR. Am J Physiol Renal Physiol. 2018 05 1;314(5):F985-F991. PubMed PMID: 29357423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acid retention in chronic kidney disease is inversely related to GFR. AU - Goraya,Nimrit, AU - Simoni,Jan, AU - Sager,Lauren N, AU - Pruszynski,Jessica, AU - Wesson,Donald E, Y1 - 2018/01/03/ PY - 2018/1/24/pubmed PY - 2019/9/4/medline PY - 2018/1/24/entrez KW - GFR KW - acidosis KW - bicarbonate KW - chronic kidney disease KW - diet SP - F985 EP - F991 JF - American journal of physiology. Renal physiology JO - Am J Physiol Renal Physiol VL - 314 IS - 5 N2 - Greater H+ retention in animal models of chronic kidney disease (CKD) mediates faster glomerular filtration rate (GFR) decline and dietary H+ reduction slows eGFR decline in CKD patients with reduced eGFR and H+ retention due to the high acid (H+) diets of developed societies. We examined if H+ retention in CKD is inversely associated with estimated GFR (eGFR) using cross-sectional and longitudinal analysis of individuals with CKD stage 1 (>90 ml·min- 1·1.73 m-2), CKD stage 2 (60-89 ml/min per 1.73 m2), and CKD stage 3 (30-59 ml·min- 1·1.73 m-2) eGFR. H+ retention was assessed using the difference between observed and expected plasma total CO2 2 h after 0.5 meq/kg body wt oral NaHCO3. H+ retention was higher in CKD 2 vs. CKD 1 (P < 0.01) and in CKD 3 vs. CKD 2 (P < 0.02) at baseline and 5 yr, and was higher in CKD 2 vs. CKD 1 (P < 0.01) at 10 yr. All groups had lower eGFR at subsequent time points (P < 0.01) but H+ retention was not different among the three time points for CKD 1. By contrast, eGFR decrease was associated with higher H+ retention in CKD 2 at 5 yr (P = 0.04) and 10 yr (P < 0.01) and with higher H+ retention in CKD 3 at 5 yr (P < 0.01). Yearly eGFR decline rate was faster in CKD 2 vs. CKD 1 (P < 0.01) and in CKD 3 vs. CKD 2 (P < 0.01). The data show that H+ retention is inversely associated with eGFR, with faster eGFR decline, and support the need for greater dietary H+ reduction therapy for CKD individuals with lower eGFR. SN - 1522-1466 UR - https://www.unboundmedicine.com/medline/citation/29357423/Acid_retention_in_chronic_kidney_disease_is_inversely_related_to_GFR_ DB - PRIME DP - Unbound Medicine ER -