Email updates

Keep up to date with the latest news and content from BMC Nephrology and BioMed Central.

Open Access Highly Accessed Research article

Dietary acid load and chronic kidney disease among adults in the United States

Tanushree Banerjee18*, Deidra C Crews23, Donald E Wesson4, Anca Tilea5, Rajiv Saran6, Nilka Rios Burrows7, Desmond E Williams7, Neil R Powe18 and for the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team

Author Affiliations

1 Department of Medicine, University of California, San Francisco, CA, USA

2 Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

3 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA

4 Texas A&M College of Medicine and Scott and White Healthcare, Texas, USA

5 Kidney Epidemiology & Cost Center, University of Michigan, Ann Arbor, MI, USA

6 Division of Nephrology, Department of Medicine and Kidney Epidemiology & Cost Center, University of Michigan, Ann Arbor, MI, USA

7 Centers of Disease and Control and Prevention, Atlanta, GA, USA

8 Department of Medicine, San Francisco General Hospital, San Francisco, CA, USA

For all author emails, please log on.

BMC Nephrology 2014, 15:137  doi:10.1186/1471-2369-15-137

Published: 24 August 2014



Diet can markedly affect acid-base status and it significantly influences chronic kidney disease (CKD) and its progression. The relationship of dietary acid load (DAL) and CKD has not been assessed on a population level. We examined the association of estimated net acid excretion (NAEes) with CKD; and socio-demographic and clinical correlates of NAEes.


Among 12,293 U.S. adult participants aged >20 years in the National Health and Nutrition Examination Survey 1999–2004, we assessed dietary acid by estimating NAEes from nutrient intake and body surface area; kidney damage by albuminuria; and kidney dysfunction by eGFR < 60 ml/min/1.73m2 using the MDRD equation. We tested the association of NAEes with participant characteristics using median regression; while for albuminuria, eGFR, and stages of CKD we used logistic regression.


Median regression results (β per quintile) indicated that adults aged 40–60 years (β [95% CI] = 3.1 [0.3–5.8]), poverty (β [95% CI] = 7.1 [4.01–10.22]), black race (β [95% CI] = 13.8 [10.8–16.8]), and male sex (β [95% CI] = 3.0 [0.7- 5.2]) were significantly associated with an increasing level of NAEes. Higher levels of NAEes compared with lower levels were associated with greater odds of albuminuria (OR [95% CI] = 1.57 [1.20–2.05]). We observed a trend toward greater NAEes being associated with higher risk of low eGFR, which persisted after adjustment for confounders.


Higher NAEes is associated with albuminuria and low eGFR, and socio-demographic risk factors for CKD are associated with higher levels of NAEes. DAL may be an important target for future interventions in populations at high risk for CKD.

Acidosis; Albuminuria; Chronic kidney disease; NHANES (National Health and Nutrition Examination Survey); Nutrition