Increased acid excretion may promote renal injury. To evaluate this in African Americans with hypertensive nephrosclerosis, we studied the association between the net endogenous acid production and progression of kidney disease in 632 patients in the AASK trial. Protein and potassium intakes were estimated from 24 h urea nitrogen and potassium excretion, and used to estimate net endogenous acid production, averaged over 2 years, approximating routine intake. The link between net endogenous acid production and the I(125)iothalamate glomerular filtration rate (iGFR) and time to end-stage renal disease or doubling of serum creatinine was analyzed using mixed models and Cox proportional hazards regressions. The trend in higher net endogenous acid production was significantly associated with a faster decline in iGFR over a median of 3.2 years. After adjustment for age, body mass index, baseline iGFR, urine protein-to-creatinine ratio, and randomized treatment group, the trend in higher net endogenous acid production remained significantly associated with a faster decline in iGFR at a rate of 1.01 ml/min per 1.73 m(2) per year faster in the highest compared to the lowest quartile. However, in time-to-event analyses over a median of 7.7 years, the adjusted hazard ratio (1.10) for composite renal events per 25 mEq/day higher net endogenous acid production was not significant. Hence, our findings implicate endogenous acid production as a potential modifiable risk factor for progressive kidney disease.
AD - Department of Medicine, University of Miami, Miami, Florida 33136, USA. jscialla@med.miami.edu AN - 22475819 BT - Kidney International DP - NLM ET - 2012/04/06 J2 - Kidney international LA - eng M1 - 1 N1 - Scialla, Julia JAppel, Lawrence JAstor, Brad CMiller, Edgar R 3rdBeddhu, SrinivasanWoodward, MarkParekh, Rulan SAnderson, Cheryl A MAfrican American Study of Kidney Disease and Hypertension Study Group2P20 RR11104/RR/NCRR NIH HHS/United States5KL2RR025006/RR/NCRR NIH HHS/United States5R01DK072367-03/DK/NIDDK NIH HHS/United StatesDK 2818-02/DK/NIDDK NIH HHS/United StatesK01HL092595-02/HL/NHLBI NIH HHS/United StatesM01 RR-00071/RR/NCRR NIH HHS/United StatesM01 RR-00080/RR/NCRR NIH HHS/United StatesM01 RR00052/RR/NCRR NIH HHS/United StatesM01 RR00827/RR/NCRR NIH HHS/United StatesM0100032/PHS HHS/United StatesP20-RR11145/RR/NCRR NIH HHS/United StatesR21DK078218/DK/NIDDK NIH HHS/United StatesRR029887/RR/NCRR NIH HHS/United StatesT32 DK 00732-14/DK/NIDDK NIH HHS/United StatesResearch Support, N.I.H., ExtramuralUnited StatesKidney Int. 2012 Jul;82(1):106-12. doi: 10.1038/ki.2012.82. Epub 2012 Apr 4. N2 -Increased acid excretion may promote renal injury. To evaluate this in African Americans with hypertensive nephrosclerosis, we studied the association between the net endogenous acid production and progression of kidney disease in 632 patients in the AASK trial. Protein and potassium intakes were estimated from 24 h urea nitrogen and potassium excretion, and used to estimate net endogenous acid production, averaged over 2 years, approximating routine intake. The link between net endogenous acid production and the I(125)iothalamate glomerular filtration rate (iGFR) and time to end-stage renal disease or doubling of serum creatinine was analyzed using mixed models and Cox proportional hazards regressions. The trend in higher net endogenous acid production was significantly associated with a faster decline in iGFR over a median of 3.2 years. After adjustment for age, body mass index, baseline iGFR, urine protein-to-creatinine ratio, and randomized treatment group, the trend in higher net endogenous acid production remained significantly associated with a faster decline in iGFR at a rate of 1.01 ml/min per 1.73 m(2) per year faster in the highest compared to the lowest quartile. However, in time-to-event analyses over a median of 7.7 years, the adjusted hazard ratio (1.10) for composite renal events per 25 mEq/day higher net endogenous acid production was not significant. Hence, our findings implicate endogenous acid production as a potential modifiable risk factor for progressive kidney disease.
PY - 2012 SN - 1523-1755 (Electronic)0085-2538 (Linking) SP - 106 EP - 12 ST - Kidney Int.Kidney Int. T2 - Kidney International TI - Net endogenous acid production is associated with a faster decline in GFR in African Americans VL - 82 ER -