最新一期的JASN刊登的一篇研究表示如果患有慢性腎病的患者飲食具有高酸含量，可能會增加腎衰竭的風險。慢性腎病患者可能要限製肉類的攝入量，增加水果和蔬菜，以幫助保護他們的腎髒。

        之前有小規模的臨床試驗結果表明，降低膳食酸負荷(dietary acid load ，DAL)能改善腎損傷，延緩腎功能衰退。可是DAL和患有慢性腎病(CKD)患者發展終末期腎病(ERSD)風險之間的關係卻不甚明了。加州大學舊金山分校的Tanushree博士和她的同事們為了研究這個問題，收集了全美1486位代表性的患有CKD成年人的樣本，通過量化淨酸排泄(NAEes)的方法檢測DAL同時追蹤患者腎病的發展。14.2年隨訪後，通過ERSD醫保注冊確認是否有晚期腎病。

        研究人員采用FINE-GRAY競爭風險的方法來評估DAL與ERSD的關聯(在考慮了人口統計，營養因素，臨床疾病，腎功能/損傷標記物等因素後)。結果發現311(20.9%)位參與者發展有ERSD，高 DAL水平增加ESRD的相關風險——相對危險(95%置信區間)為3.04(1.58~5.86)為高，1.81(0.89~3.68)為中等水平。參與者如果有蛋白尿，高DAL顯示與ESRD的風險強烈相關。所以較高水平的膳食酸負荷與發展腎功能衰竭強烈聯係在一起。消耗高酸的飲食患者比消耗低酸性飲食的病人發展腎功能衰竭可能高出三倍。

        低酸負荷飲食包括豐富的水果和蔬菜，而高酸的飲食中含有較多的肉類。患有慢性腎髒疾病可能要多注意飲食中酸豐富的食物，以減少發展為腎功能衰竭可能，同時聽從醫生建議，服用藥物，避免腎毒素。Tanushree博士表示：透析治療帶來高費用和欠佳生活質量可采用更健康的含有豐富的水果和蔬菜的飲食來避免。

        doi: 10.1681/ASN.2014040332

High Dietary Acid Load Predicts ESRD among Adults with CKD

        Tanushree Banerjee, Deidra C. Crews, Donald E. Wesson, Anca M. Tilea, Rajiv Saran, Nilka Ríos-Burrows, Desmond E. Williams, Neil R. Powe,

        Small clinical trials have shown that a reduction in dietary acid load (DAL) improves kidney injury and slows kidney function decline; however, the relationship between DAL and risk of ESRD in a population-based cohort with CKD remains unexamined. We examined the association between DAL, quantified by net acid excretion (NAEes), and progression to ESRD in a nationally representative sample of adults in the United States. Among 1486 adults with CKD age≥20 years enrolled in the National Health and Nutrition Examination Survey III, DAL was determined by 24-h dietary recall questionnaire. The development of ESRD was ascertained over a median 14.2 years of follow-up through linkage with the Medicare ESRD Registry. We used the Fine–Gray competing risks method to estimate the association of high, medium, and low DAL with ESRD after adjusting for demographics, nutritional factors, clinical factors, and kidney function/damage markers and accounting for intervening mortality events. In total, 311 (20.9%) participants developed ESRD. Higher levels of DAL were associated with increased risk of ESRD; relative hazards (95% confidence interval) were 3.04 (1.58 to 5.86) for the highest tertile and 1.81 (0.89 to 3.68) for the middle tertile compared with the lowest tertile in the fully adjusted model. The risk of ESRD associated with DAL tertiles increased as eGFR decreased (P trend=0.001). Among participants with albuminuria, high DAL was strongly associated with ESRD risk (P trend=0.03). In conclusion, high DAL in persons with CKD is independently associated with increased risk of ESRD in a nationally representative population.