最新一期的JASN刊登的一篇研究表示如果患有慢性肾病的患者饮食具有高酸含量，可能会增加肾衰竭的风险。慢性肾病患者可能要限制肉类的摄入量，增加水果和蔬菜，以帮助保护他们的肾脏。

        之前有小规模的临床试验结果表明，降低膳食酸负荷(dietary acid load ，DAL)能改善肾损伤，延缓肾功能衰退。可是DAL和患有慢性肾病(CKD)患者发展终末期肾病(ERSD)风险之间的关系却不甚明了。加州大学旧金山分校的Tanushree博士和她的同事们为了研究这个问题，收集了全美1486位代表性的患有CKD成年人的样本，通过量化净酸排泄(NAEes)的方法检测DAL同时追踪患者肾病的发展。14.2年随访后，通过ERSD医保注册确认是否有晚期肾病。

        研究人员采用FINE-GRAY竞争风险的方法来评估DAL与ERSD的关联(在考虑了人口统计，营养因素，临床疾病，肾功能/损伤标记物等因素后)。结果发现311(20.9%)位参与者发展有ERSD，高 DAL水平增加ESRD的相关风险——相对危险(95%置信区间)为3.04(1.58~5.86)为高，1.81(0.89~3.68)为中等水平。参与者如果有蛋白尿，高DAL显示与ESRD的风险强烈相关。所以较高水平的膳食酸负荷与发展肾功能衰竭强烈联系在一起。消耗高酸的饮食患者比消耗低酸性饮食的病人发展肾功能衰竭可能高出三倍。

        低酸负荷饮食包括丰富的水果和蔬菜，而高酸的饮食中含有较多的肉类。患有慢性肾脏疾病可能要多注意饮食中酸丰富的食物，以减少发展为肾功能衰竭可能，同时听从医生建议，服用药物，避免肾毒素。Tanushree博士表示：透析治疗带来高费用和欠佳生活质量可采用更健康的含有丰富的水果和蔬菜的饮食来避免。

        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.