ACID‐BASE IN RENAL FAILURE: Influence of Diet on Acid‐Base Balance

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Abstract
It is well established that diet and certain food components have a clear impact on acid-base balance. For adults, the following factors are involved: 1) the chemical composition of foods (i.e., their content of protein, chloride, phosphorus, sodium, potassium, calcium, and magnesium), 2) the different intestinal absorption rates of the relevant nutrients, 3) the metabolic generation of sulfate from sulfur-containing amino acids, 4) the grade of dissociation of phosphorus at the physiologic pH of 7.4, and 5) the ionic valence of calcium and magnesium. All these factors allow us to estimate the potential renal acid load (PRAL) of any given food or diet. The PRAL (calculated for a 24-hour period), together with a relatively constant daily amount of urinary excreted organic acids (in healthy subjects proportional to body surface area or body weight), yields the daily net acid excretion. This article provides an overview of the current concepts of diet influences on acid-base balance and also focuses on the underlying physiologic and biochemical basis as well as on relevant clinical implications.