Dietary acid load, kidney function and risk of chronic kidney disease: A systematic review and meta-analysis of observational studies

Abstract. Aim: Study findings examining the association between dietary acid load (DAL), kidney function and risk of chronic kidney disease (CKD) are inconsistent and there has been no meta-analysis on the relationship between DAL, kidney function and risk of CKD, hence we investigated this association in this paper. Methods: PubMed, ISI web of science and Scopus were searched up to January 2018 to identify all relevant articles. Effect sizes of eligible studies were pooled in random- effect model using the Der Simonian-Laird method. The I 2 index was used to assess the amount of heterogeneity. Result: Twenty three studies with 200092 subjects were included. Meta-analysis of 9 observational studies showed that DAL had a positive significant association with risk of CKD (1.31; 95% CI: 1.06, 1.62; P = 0.011). Furthermore, increased DAL can decrease urine pH (−0.47; 95% CI: −0.85, −0.08; P = 0.017) significantly. Subgroup analysis could not identify the sources of heterogeneity about the association of DAL and risk of CKD. However, it showed the method of measurement was the source of heterogeneity about the association of DAL and urine pH (24 h urine pH: −0.62; 95% CI: −0.70, −0.54; P < 0.0001; Fasting urine pH: −0.08; 95% CI: −0.18, 0.02; P = 0.111). Conclusion: Our study showed that DAL can increase the risk of CKD and have an inverse association with urine pH.