Association of Dietary Acid Load (DAL) and Cardiovascular Risk Factors in Hemodialysis Patient: The Pilot Study

Abstract

Aim: Diets high in sulfur-rich protein and low fruits and vegetables affect human acid-base balance adversely and can have a harmful effect on progression of chronic kidney disease (CKD). Little is known about the potential influence of diet on cardiovascular risk factors in hemodialysis patients. This study examined the association of dietary acid load with cardiovascular risk factors in hemodialysis patients. Subject and Methods: The present study includes 23 male and 17 female with a total of 40 HD patients (53.8±8.20 year) including undergoing maintenance hemodialysis for more than 1 years. General characteristics of the patients were found with the survey method. Food consumption including a dialysis day and two non-dialysis days were taken with “food consumption record” method and dietary acid load (DAL) that enables the prediction of endogenous acid production was calculated using the PRAL and NEAP method. The results of blood samples in routine were taken from computer records of the dialysis center. Multiple regression analysis to examine the relationship between nutrients and food groups with PRAL levels; risk measure of the independent variables that may affect the PRAL was calculated using Binary Logistic Regression method. Results: While PRAL average of the patients in the study for males (14.5±15.48 mEq/day) was higher than females (12.7±7.09 mEq/day) (p<0.05), NEAP average for women (64.2±17.26 mEq/day) was higher than men (61.7±19.32 mEq/day). Difference between the PRAL average of the patients who have risk factors which are being diabetes mellitus (16.6±18.88 mEq/day), smoking (19.5±21.54 mEq/day) and having serum calcium level above 10.2 mmol/L (15.9 ± 24.74 mEq/day) were statistically significant (p<0.05). It was found that there were very high statistical significant relation between level of PRAL and nutritional component. The effect of intake dietary protein, calcium, potassium, magnesium, phosphorus and cholesterol on PRAL level was determined statistically significant (p<0.05). It was identified that there was a statistically substantial relationship between the PRAL level and food groups except for milk and cheese (R=0.876, p<0.05). Conclusion: It was found a relationship between certain cardiovascular risk factors and high dietary acid load in hemodialysis patients. However, more studies are needed to fully explain this relationship