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Abstract: PO2025

Dietary Acid Load Is Associated with the Risk of Mortality and Kidney Replacement Therapy in Diabetic CKD Patients but Not in Non-Diabetics

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Machado, Alisson Diego, Department of Nephrology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
  • Marchioni, Dirce, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
  • Lotufo, Paulo, Clinical Research Center, Universitary Hospital, University of São Paulo, São Paulo, São Paulo, Brazil
  • Bensenor, Isabela M., Clinical Research Center, Universitary Hospital, University of São Paulo, São Paulo, São Paulo, Brazil
  • Titan, Silvia M., Department of Nephrology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
Background

Dietary acid load (DAL) may be related to CKD progression but results are still conflicting. In addition, no studies have evaluated the association of DAL with mortality in CKD. The aim of this study was to evaluate two estimates of DAL, PRAL (potential renal acid load) and NEAP (net-endogenous acid production), in relation to events of mortality and kidney replacement therapy (KRT) in CKD.

Methods

Baseline clinical and dietary data (food frequency questionnaire) from the PROGREDIR Cohort (n=454), a CKD cohort based on Sao Paulo, Brazil, composed predominantly of older people with CKD G3 and G4 was used in this analysis. PRAL and NEAP were computed using previously validated formulas, and those with missing values were excluded (n=11). Events of death (n=190) and KRT (n=62) were ascertained after a median follow-up time of 6 years. Uni and multivariable Cox proportional hazards and Competitive Risk models were computed.

Results

Mean age was 68 ± 12 y, mean eGFR was 38 ± 15 mL/min/1.73m2, 63% were male and 56% were diabetic. Mean intake of PRAL and NEAP were 4.1 ± 18.5 and 51.9 ± 17.4 mEq/d, respectively. Initially, neither PRAL nor NEAP were associated with mortality or KRT. However, after stratification for diabetes, both estimates were positively related to the risk of KRT and death in diabetics only, even after adjustments (Table). Competing risk analysis were consistent with the Cox findings. By entering interaction terms between diabetes and DAL estimates, which were significant, both PRAL and NEAP showed an inverse association with the risk of clinical events.

Conclusion

Our results suggest the existence of a relevant interaction between PRAL/NEAP and diabetes: whereas DAL estimates were associated with mortality and KRT in diabetics, this association was not observed in non-diabetics.

 DEATHKRT
 HR (95% CI)pHR (95% CI)p
All participants (n = 443)
PRAL0.999 (0.992 to 1.007)0.891.009 (0.995 to 1.023)0.23
NEAP0.998 (0.990 to 1.007)0.711.008 (0.995 to 1.022)0.24
Diabetes only (n = 250)
PRAL1.008 (0.997 to 1.019)0.151.026 (1.006 to 1.045)0.01
adj.*1.016 (1.001 to 1.032)0.041.027 (1.000 to 1.054)0.05
NEAP1.010 (0.999 to 1.021)0.071.026 (1.008 to 1.045)0.005
adj.*1.019 (1.005 to 1.033)0.011.025 (1.001 to 1.050)0.04

*Adjusted for age, sex, eGFR, bicarbonate, and energy and protein intakes.

Funding

  • Government Support - Non-U.S.