Work

Renal Net Acid Excretion During Growth and eGFR, Creatinine Clearance, and Albuminuria in Young Adulthood

Year: 2025

Type: article

Abstract: Rationale & Objective Metabolic acidosis and reduced serum bicarbonate levels are known to contribute to renal disease progression. Whether a habitual high net endogenous acid production early in life may already have consequences for long-term kidney function is not known. To date no longitudinal study has examined the relationship between regular net acid excretion (NAE) during childhood and adolescence and later adult albumin excretion, eGFR, and creatinine clearance (CrCl). Study Design Open cohort study examining healthy children from infancy to adulthood. Setting & Participants Study participants with multiple 24-h urine collections between ages 3 and 17 years who provided a blood sample between 18 and 35 years. Exposure Pre-adulthood NAE and its components ammonium excretion, titratable acidity, and pH. Outcomes Adults' eGFR, creatinine clearance (CrCl), and albumin-creatinine ratio (Alb/Crea). Analytical Approach Sex- and age-stratified standard deviation scores (SDS) calculated for anthropometric and urinary biomarkers were averaged for each individual and the relationships between the urinary exposures and adulthood eGFR, CrCl, and Alb/Crea were examined using multiple linear regression analysis. Regression models were adjusted for pre-adulthood nutrition-related renal biomarker-SDSs and various adult parameters. Results In fully adjusted models, children's and adolescents' repeatedly measured renal NAE and titratable acidity associated strongly inversely and their 24-h urine pH highly significantly positively with eGFR in adulthood. Similar findings were seen for CrCl. Pre-adulthood ammonium excretion was significantly positively related only to Alb/Crea in adulthood. Limitations Outcomes determined only once. Conclusions These exclusively biomarker-based findings strongly suggest that even only habitually increased NAE and corresponding low urine pH values in the normal range in childhood and youth are already related to incipient signs of renal function decline. Hence as an important kidney health prevention measure, habitual consumption of alkalizing fruit- and vegetable-rich diets with a clear ammoniagenesis and NAE-lowering efficiency should start early in childhood.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2025.101195

Authors: Thomas Remer, Seyedeh-Masomeh Derakhshandeh-Rishehri, Yifan Hua, Luciana Peixoto Franco, Hermann Kalhoff, Stefan A. Wudy

Institutions: University of Bonn, St. Josef-Hospital, Ruhr University Bochum, Justus-Liebig-Universität Gießen

Language: English

Topic: Renal function and acid-base balance

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,590