Renal Net Acid Excretion Capacity Is Comparable in Prepubescence, Adolescence, and Young Adulthood but Falls with Aging

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 56; no. 8; pp. 1442 - 1448
• Main Authors: Berkemeyer, Shoma, Vormann, Jürgen, Günther, Anke L. B., Rylander, Ragnar, Frassetto, Lynda A., Remer, Thomas
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.08.2008; Blackwell; Wiley Subscription Services, Inc
• Subjects: acid-base; Acid-Base Equilibrium - physiology; Adolescent; Adult; Aged; Aging; Aging - physiology; Anthropometry; Biological and medical sciences; Child; Creatinine - urine; Cross-Sectional Studies; Female; General aspects; Germany; healthy subjects; Humans; Hydrogen-Ion Concentration; Kidney Function Tests; Kidneys; Male; Medical disorders; Medical sciences; Middle Aged; Miscellaneous; Nephrology; net acid excretion capacity; Nitrogen - urine; Older people; Phosphorus - urine; protein; Public health. Hygiene; Public health. Hygiene-occupational medicine; renal function; Sweden; Sweden; Germany; Human; Kidney disease; Excretion; Senescence; Urinary system disease; Renal function; Healthy subject; healthy subjects; Ageing; net acid excretion capacity; Base; Protein; Kidney; Urinary system; Acids; Capacity; Adolescent; Young adult; Fall; Pharmacokinetics; acid-base; Elderly; Geriatrics
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/j.1532-5415.2008.01799.x

OBJECTIVES: To evaluate whether renal net acid excretion capacity (NAEC) varies across different age groups and, specifically, whether it falls in elderly people. DESIGN: Cross‐sectional observational study. SETTING: Community‐based. PARTICIPANTS: Young participants were from the DOrtmund Nutritional and Anthropometric Longitudinally Designed Study, Dortmund, Germany; elderly participants were from Gothenburg, Sweden. MEASUREMENTS: Twenty‐four‐hour urine pH, net acid excretion (NAE), urinary phosphorus, total nitrogen excretion, and anthropometric data were measured in healthy elderly people (aged 55–75; n=85), young adults (aged 18–22; n=117), adolescents (aged 13–14; n=112), and prepubescent children (aged 6–7; n=217). NAEC was determined as 24‐hour NAE adjusted for urine pH using the residual method. RESULTS: In elderly participants 24‐hour urinary pH (5.9±0.53) was lower (P<.05) and NAE (60±27 mEq/d) higher (P<.05) than in the three other groups. In a regression model adjusted for age, sex, and body surface area, NAEC showed a clear decrease with age, with highest values in prepubescents and lowest in elderly participants. However, NAEC remained significantly lower only in elderly participants (P<.001) after the inclusion of total nitrogen excretion, a protein intake index, which was included because protein intake is known to modulate renal function. NAEC was approximately 8 mEq/d lower in healthy elderly participants than in young adults. CONCLUSION: The capacity to excrete net endogenous acid does not vary markedly from childhood to young adulthood but falls significantly with age, implying that elderly people may require higher daily alkalizing mineral intake to compensate for renal function losses.