Background: Diet can markedly affect acid-base status and it significantly influences chronic kidney disease (CKD)\nand its progression. The relationship of dietary acid load (DAL) and CKD has not been assessed on a population\nlevel. We examined the association of estimated net acid excretion (NAEes) with CKD; and socio-demographic and\nclinical correlates of NAEes.\nMethods: Among 12,293 U.S. adult participants aged >20 years in the National Health and Nutrition Examination\nSurvey 1999ââ?¬â??2004, we assessed dietary acid by estimating NAEes from nutrient intake and body surface area; kidney\ndamage by albuminuria; and kidney dysfunction by eGFR < 60 ml/min/1.73m2 using the MDRD equation. We\ntested the association of NAEes with participant characteristics using median regression; while for albuminuria, eGFR,\nand stages of CKD we used logistic regression.\nResults: Median regression results (? per quintile) indicated that adults aged 40ââ?¬â??60 years (? [95% CI] = 3.1 [0.3ââ?¬â??5.8]),\npoverty (? [95% CI] = 7.1 [4.01ââ?¬â??10.22]), black race (? [95% CI] = 13.8 [10.8ââ?¬â??16.8]), and male sex (? [95% CI] = 3.0 [0.7- 5.2])\nwere significantly associated with an increasing level of NAEes. Higher levels of NAEes compared with lower levels were\nassociated with greater odds of albuminuria (OR [95% CI] = 1.57 [1.20ââ?¬â??2.05]). We observed a trend toward greater NAEes\nbeing associated with higher risk of low eGFR, which persisted after adjustment for confounders.\nConclusion: Higher NAEes is associated with albuminuria and low eGFR, and socio-demographic risk factors for CKD are\nassociated with higher levels of NAEes. DAL may be an important target for future interventions in populations at high risk\nfor CKD.
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