title: A low-salt diet increases the estimated net endogenous acid production in nondiabetic chronic kidney disease patients treated with angiotensin receptor blockade.
abstract: OBJECTIVE
  An acid-base imbalance precedes renal disease progression in patients with chronic kidney disease (CKD). Little is known about the effects of a low-salt diet (LSD) on net endogenous acid production (NEAP) levels in CKD patients using angiotensin receptor blockade.
  
  
  METHODS
  We enrolled a total of 202 nondiabetic CKD patients who underwent an 8-week treatment with olmesartan from the original trial [Effects of Low Sodium Intake on the Antiproteinuric Efficacy of Olmesartan in Hypertensive Patients with Albuminuria (ESPECIAL) trial: NCT01552954]. The patients were divided into good- and poor-LSD-compliance groups.
  
  
  RESULTS
  During the interventional 8 weeks, the NEAP in the good-compliance group increased compared to the control group (12.9 ± 32.0 vs. -2.0 ± 35.0 mmol/day, p = 0.002). NEAP was positively associated with the good-LSD-compliance group in the fully adjusted analyses (r = 0.135, p = 0.016). The additional reduction of 2.39 g/day of protein intake with a reduction of 1 g/day of salt intake did not increase the NEAP under angiotensin II receptor blockade (ARB) treatment with an LSD (r = 0.546, p < 0.001).
  
  
  CONCLUSIONS
  We found that an LSD may increase the NEAP in nondiabetic CKD patients using ARB, which suggests that additional acid producing-protein restriction should be required to prevent the NEAP from rising.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Seon Ha
authors.initials: SH
authors.lastname: Baek
authors.forename: Sejoong
authors.initials: S
authors.lastname: Kim
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Park
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Shin
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Chin
authors.forename: Suhnggwon
authors.initials: S
authors.lastname: Kim
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Lim
mesh_terms: D000136:Acid-Base Equilibrium; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D004039:Diet, Sodium-Restricted; D018450:Disease Progression; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy* / Q000188:drug therapy*; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D016482:Urinalysis
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan