Dietary Acid Load and Incident Chronic Kidney Disease: Results from the ARIC Study
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BACKGROUND: Higher dietary acid load can result in metabolic acidosis and is associated with faster kidney disease progression in patients with chronic kidney disease (CKD). However, the relationship between dietary acid load and incident CKD has not been evaluated. METHODS: We conducted prospective analyses of the Atherosclerosis Risk in Communities study participants without CKD at baseline (1987-1989, n = 15,055). Dietary acid load was estimated using the equation for potential renal acid load by Remer and Manz, incorporating dietary intake data from a food frequency questionnaire. Incident CKD was assessed from baseline through 2010 and defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 accompanied by 25% eGFR decline, CKD-related hospitalization or death or end-stage renal disease identified by linkage to the US Renal Data System registry. RESULTS: In the overall study population, 55% were female, 26% were African-American and mean age at baseline was 54 years. During a median follow-up of 21 years, there were 2,351 (15.6%) incident CKD cases. After adjusting for demographics (age, sex, race-center), established risk factors (diabetes status, hypertension status, overweight/obese status, smoking status, education level, physical activity), caloric intake and baseline eGFR, higher dietary acid load were associated with higher risk of incident CKD (hazard ratio [HR] for quartile 4 vs. 1: 1.13, 95% CI 1.01-1.28, p for trend = 0.02; HR per interquartile range increase: 1.06, 95% CI 1.00-1.11, p = 0.04). CONCLUSION: Dietary acid load is associated with incident CKD in a population-based sample. These data suggest a potential avenue for CKD risk reduction through diet.
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Dietary renal acid load is positively associated with chronic kidney disease incidence in a large cohort (n = 15,055) from the Atherosclerosis Risk in Communities study.
“dietary renal acid load was positively associated with chronic kidney disease (CKD) incidence”
From Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function (2020) · cites this paper as [100]
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- Authors
- Rebholz, C. M., Coresh, J., Grams, M. E., Steffen, L. M., Anderson, C. A. M., Appel, L. J., & Crews, D. C.
- Affiliations
- Johns Hopkins University (US)
- University of Minnesota (US)
- ORCID
- Venue
- American Journal of Nephrology
- Publisher
- S. Karger AG
- Published
- 2015
- Volume
- 42
- Issue
- 6
- Pages
- 427-435
- ISSN
- 0250-8095 (ISSN-L)
- 1421-9670
- PMC
- PMC4733508
- OpenAlex
- W2277082532
- Cited by
- 173
- References
- 45
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 14 · 2023: 16 · 2022: 24 · 2021: 20 · 2020: 24 · 2019: 17 · 2018: 14 · 2017: 17 · 2016: 9 · 2015: 1
- FWCI
- 11.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HHSN268201 100012C, HHSN268201100007I, HHSN268201100007C, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN2682011-00005I, HHSN2682011-00009I, HHSN268201100005C, HHSN268201100005G, HHSN268201100010C, HHSN268201100011I, HHSN26820 1100009C, HHSN2682011-00008I)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK097184, K08DK092287, P30DK072488)
- Topics
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Kidney Stones and Urolithiasis Treatments
- Keywords
- dietary acid load, chronic kidney disease, incident CKD, metabolic acidosis, potential renal acid load, estimated glomerular filtration rate decline, end-stage renal disease, dietary risk factors, Atherosclerosis Risk in Communities Study
- MeSH terms
- Acidosis, Acids, Adult, Aged, Diet, Dietary Proteins, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Kidney, Kidney Failure, Chronic, Magnesium, Male, Middle Aged, Prospective Studies, Registries, Risk Factors, United States, Incidence, Proportional Hazards Models, Renal Insufficiency, Chronic
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