Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease

Julia J. Scialla, Lawrence J. Appel, Brad C. Astor, Edgar R. Miller, Srinivasan Beddhu, Mark Woodward, Rulan S. Parekh, Cheryl A M Anderson

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)1526-1532
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number7
DOIs
StatePublished - Jul 1 2011

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Bicarbonates
Chronic Renal Insufficiency
African Americans
Acids
Serum
Dietary Proteins
Dietary Potassium
Acidosis
Potassium
Alkalies
Vegetables
Disease Progression
Urea
Linear Models
Fruit
Nitrogen
Sodium
Demography
Morbidity
Kidney

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Scialla, J. J., Appel, L. J., Astor, B. C., Miller, E. R., Beddhu, S., Woodward, M., ... Anderson, C. A. M. (2011). Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. Clinical Journal of the American Society of Nephrology, 6(7), 1526-1532. https://doi.org/10.2215/CJN.00150111

Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. / Scialla, Julia J.; Appel, Lawrence J.; Astor, Brad C.; Miller, Edgar R.; Beddhu, Srinivasan; Woodward, Mark; Parekh, Rulan S.; Anderson, Cheryl A M.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 7, 01.07.2011, p. 1526-1532.

Research output: Contribution to journalArticle

Scialla, JJ, Appel, LJ, Astor, BC, Miller, ER, Beddhu, S, Woodward, M, Parekh, RS & Anderson, CAM 2011, 'Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease', Clinical Journal of the American Society of Nephrology, vol. 6, no. 7, pp. 1526-1532. https://doi.org/10.2215/CJN.00150111
Scialla, Julia J. ; Appel, Lawrence J. ; Astor, Brad C. ; Miller, Edgar R. ; Beddhu, Srinivasan ; Woodward, Mark ; Parekh, Rulan S. ; Anderson, Cheryl A M. / Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 7. pp. 1526-1532.
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