Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation · 2026
Effects of a Low-PRAL Modified New Nordic Renal Diet on Acid-Base Status in Patients With Stage 4-5 Chronic Kidney Disease and Chronic Metabolic Acidosis.
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Wittendorff Pedersen Anna Elvina, Rousing Amalie Quist, Berg Peder, Christensen Julie Friis, Hansen Henriette Watson, Brandi Linea Cecilie, Sørensen Mads Vaarby, Hansen Ditte, Brandi Lisbet, Andersen Jens Rikardt, Salomo Louise
Аннотация
OBJECTIVE: Metabolic acidosis is a common complication in chronic kidney disease (CKD) and is associated with accelerated disease progression. Diets with a low potential renal acid load (PRAL) represent a promising non-pharmacological strategy to mitigate metabolic acidosis. The New Nordic Renal Diet (NNRD), a plant-focused, low-phosphorus diet, improves acid-base status in patients with CKD stage 3-4. This study evaluated the effects of a two-week, low-PRAL modified NNRD in patients with advanced CKD and chronic metabolic acidosis.
DESIGN AND METHODS: Twelve patients with CKD stage 4-5 and metabolic acidosis completed a prospective, sequential dietary intervention consisting of three consecutive two-week periods: habitual diet (control), low-PRAL modified NNRD (intervention), and free-living follow-up without dietary guidance. The intervention consisted of individualized low-PRAL recipes. Fasting blood samples, 24-hour urine collections, and clinical measures were obtained throughout the study.
RESULTS: During the intervention, PRAL and net endogenous acid production decreased significantly (-17.2 mmol/day, 95% CI: -23.1 to -11.3 and -17.4, 95% CI: -23.3 to -11.3, respectively). No changes in plasma tCO2 were observed. Net acid excretion decreased slightly (4.1 mmol/d, 95% CI: -8.2 to -0.1). Clinically meaningful reductions were noted in albuminuria (-22.1%, 95% CI: -32.3 to -10.4), and systolic blood pressure (-17 mmHg, 95% CI: -22 to -12).
CONCLUSION: A two-week low-PRAL NNRD reduced dietary acid load but did not correct chronic metabolic acidosis in patients with CKD stage 4-5. This likely reflects severely diminished renal acid excretory capacity in late-stage CKD, where endogenous acid production still exceeds the renal capacity.
DESIGN AND METHODS: Twelve patients with CKD stage 4-5 and metabolic acidosis completed a prospective, sequential dietary intervention consisting of three consecutive two-week periods: habitual diet (control), low-PRAL modified NNRD (intervention), and free-living follow-up without dietary guidance. The intervention consisted of individualized low-PRAL recipes. Fasting blood samples, 24-hour urine collections, and clinical measures were obtained throughout the study.
RESULTS: During the intervention, PRAL and net endogenous acid production decreased significantly (-17.2 mmol/day, 95% CI: -23.1 to -11.3 and -17.4, 95% CI: -23.3 to -11.3, respectively). No changes in plasma tCO2 were observed. Net acid excretion decreased slightly (4.1 mmol/d, 95% CI: -8.2 to -0.1). Clinically meaningful reductions were noted in albuminuria (-22.1%, 95% CI: -32.3 to -10.4), and systolic blood pressure (-17 mmHg, 95% CI: -22 to -12).
CONCLUSION: A two-week low-PRAL NNRD reduced dietary acid load but did not correct chronic metabolic acidosis in patients with CKD stage 4-5. This likely reflects severely diminished renal acid excretory capacity in late-stage CKD, where endogenous acid production still exceeds the renal capacity.