The Continuum of Acid Stress

Area of Science:

• Nephrology
• Biochemistry
• Dietary Science

Background:

• Chronic metabolic acidosis is linked to kidney and organ damage.
• Acid accumulation precedes decreased plasma bicarbonate, a hallmark of metabolic acidosis.
• Even without overt metabolic acidosis, acid accumulation (eubicarbonatemic acidosis) can worsen chronic kidney disease (CKD).

Purpose of the Study:

• To re-evaluate the concept of acid-related kidney injury.
• To propose a continuum of acid stress impacting kidney health.
• To broaden the scope of intervention beyond established metabolic acidosis.

Main Methods:

• Literature review of studies on acid-base balance and kidney injury.
• Analysis of evidence linking dietary acid load to kidney disease.
• Synthesis of findings to support a spectrum of acid-related harm.

Main Results:

• Evidence suggests that acid accumulation, even below the threshold for metabolic acidosis, contributes to kidney injury.
• Chronic activation of acid-buffering systems, often due to Western diets, is associated with kidney damage.
• A continuum of "acid stress" exists, ranging from severe metabolic acidosis to dietary acid load.

Conclusions:

• Kidney injury associated with acid-related conditions should be viewed as a spectrum, not isolated events.
• Interventions targeting acid reduction may benefit a wider range of patients than previously considered.
• Dietary acid-producing potential is a significant factor in kidney health and disease progression.