Race/Ethnicity, Dietary Acid Load, and Risk of End-Stage Renal Disease among US Adults with Chronic Kidney Disease

Deidra C. Crews, Tanushree Banerjee, Donald E. Wesson, Hal Morgenstern, Rajiv Saran, Nilka Ríos Burrows, Desmond E. Williams, Neil R. Powe

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: Dietary acid load (DAL) contributes to the risk of CKD and CKD progression. We sought to determine the relation of DAL to racial/ethnic differences in the risk of end-stage renal disease (ESRD) among persons with CKD. Methods: Among 1,123 non-Hispanic black (NHB) and non-Hispanic white (NHW) National Health and Nutrition Examination Survey III participants with estimated glomerular filtration rate 15-59 mL/min/1.73 m 2 , DAL was estimated using the Remer and Manz net acid excretion (NAE es ) formula and 24-h dietary recall. ESRD events were ascertained via linkage with Medicare. A competing risk model (accounting for death) was used to estimate the hazard ratio (HR) for treated ESRD, comparing NHBs with NHWs, adjusting for demographic, clinical and nutritional factors (body surface area, total caloric intake, serum bicarbonate, protein intake), and NAE es . Additionally, whether the relation of NAE es with ESRD risk varied by race/ethnicity was tested. Results: At baseline, NHBs had greater NAE es (50.9 vs. 44.2 mEq/day) than NHWs. It was found that 22% developed ESRD over a median of 7.5 years. The unadjusted HR comparing NHBs to NHWs was 3.35 (95% CI 2.51-4.48) and adjusted HR (for factors above) was 1.68 (95% CI 1.18-2.38). A stronger association of NAE with risk of ESRD was observed among NHBs (adjusted HR per mEq/day increase in NAE 1.21, 95% CI 1.12-1.31) than that among NHWs (HR 1.08, 95% CI 0.96-1.20), p interaction for race/ethnicity × NAE es = 0.004. Conclusions: Among US adults with CKD, the association of DAL with progression to ESRD is stronger among NHBs than NHWs. DAL is worthy of further investigation for its contribution to kidney outcomes across race/ethnic groups.

Original languageEnglish (US)
Pages (from-to)174-181
Number of pages8
JournalAmerican Journal of Nephrology
Issue number3
StatePublished - Apr 1 2018


  • Acid-base
  • Epidemiology
  • Incidence

ASJC Scopus subject areas

  • Nephrology


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