Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease

详细信息    查看全文

• 作者：Halil O. Ikizler ; BA^&lowast ; ; ^&dagger ; ; Leila Zelnick ; MS^&dagger ; ; John Ruzinski ; BS^&dagger ; ; Laura Curtin ; BA^&dagger ; ; Kristina M. Utzschneider ; MD^&Dagger ; ; Bryan Kestenbaum ; MD ; MS^&dagger ; ; ^§ ; ; ^&para ; ; Jonathan Himmelfarb ; MD^&dagger ; ; ^§ ; ; Ian H. de Boer ; MD ; MS^&dagger ; ; ^§ ; ; ^&para ; ; ^{deboer@u.washington.edu" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Journal of Renal Nutrition
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：26
• 期：2
• 页码：93-102
• 全文大小：505 K

文摘

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.

absSec_2">Design

abspara0015">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.

absSec_3">Subjects

abspara0020">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 m²).

absSec_4">Main Outcome Measures

abspara0025">Serum bicarbonate and insulin sensitivity (SI_clamp).

absSec_5">Results

abspara0030">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 m² and 24.1 ± 2.9 mEq/L for participants with CKD and 88.6 ± 14.5 mL/minute/1.73 m² 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 SI_clamp. Serum bicarbonate was also not significantly associated with SI_clamp.

absSec_6">Conclusions

abspara0035">In CKD, dietary acid load is associated with serum bicarbonate, suggesting that acidosis may be improved by dietary changes, but not with insulin sensitivity.