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Published on: May 22, 2019
Dietary acid load in children with chronic kidney disease
Michelle López1, Greysi Moreno2, Gustavo Lugo3
1Department of Nephrology, Children's Hospital José Manuel de los Ríos. Departament of Pediatrics, Centro Médico Docente La Trinidad, Caracas, Venezuela. michellelopez27@gmail.com.
Insights
Children with chronic kidney disease (CKD) in Venezuela exhibit dietary patterns contributing to metabolic acidosis, a risk factor for disease progression. Assessing potential renal acid load (PRAL) is crucial for nutritional guidance in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
- Metabolic Health
Background:
- Western diets are linked to high acid loads, potentially causing metabolic acidosis.
- Metabolic acidosis is a known contributor to the progression of chronic kidney disease (CKD).
- Understanding dietary acid load is crucial for managing pediatric CKD.
Purpose of the Study:
- To estimate the potential renal acid load (PRAL) in children with CKD.
- To evaluate the acid-base status in these patients.
- To identify dietary factors contributing to metabolic acidosis in pediatric CKD.
Main Methods:
- Studied 27 children with CKD in Caracas, Venezuela.
- Assessed diet using food frequency questionnaires and 24-h intake reminders.
- Calculated PRAL using the Remer and Manz method; analyzed serum creatinine, electrolytes, and venous gases.
Main Results:
- Protein intake exceeded recommendations in 78.6% of patients; vegetable and fruit intake was low.
- Mean PRAL was 16 ± 10.7 mEq/day, correlating positively with energy, protein, and fat intake.
- 80.7% of patients had metabolic acidosis, with serum pH 7.3 ± 0.08 and bicarbonate 20.46 ± 4.5 mEq/L.
Conclusions:
- The dietary patterns of Venezuelan children with CKD may promote metabolic acidosis, risking disease progression.
- Unfavorable dietary acid loads are implicated in the progression of pediatric CKD.
- PRAL assessment is recommended for nutritional counseling in children with CKD.
Background/Objectives:
Western diet is characterized by a high acid load that could generate various degrees of metabolic acidosis, of which at least the stronger forms are known to contribute to the progression of chronic kidney disease (CKD). The aim of this study was to estimate the potential renal acid load (PRAL) and acid base status in CKD patients attended at the Children's Hospital J.M. de los Ríos in Caracas, Venezuela from April 2015 to February 2016.
Subjects/Methods:
Twenty-seven children with CKD were included. Diet composition was evaluated by a food frequency questionnaire and a 24-h intake reminder. PRAL was calculated by the Remer and Manz method. Laboratory tests included serum creatinine, electrolytes and venous gases.
Results:
Protein intake was above recommendations in 21 patients (78.6%). Average vegetable and fruit intake was 0.4 and 1.5 servings per day, respectively. Mean PRAL was 16 ± 10.7 mEq/day. PRAL correlated positively with energy (p = 0.005), protein (p = 0.001) and fat intake (p = 0.0001), daily servings of dairy (p = 0.04) meat (p = 0.001) and cereals (0.001) and negatively with vegetable intake (p = 0.04). Serum pH and bicarbonate were 7.3 ± 0.08 and 20.46 ± 4.5 mEq/L, respectively. Twenty-one patients (80.7%) with metabolic acidosis were treated with sodium bicarbonate.
Conclusions:
Dietary pattern of Venezuelan children with CKD may constitute a risk factor for the progression of the disease by promoting metabolic acidosis via unfavorable dietary acid loads. PRAL should be assessed as a valuable guide for nutritional counseling in children with CKD.
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