Ammonium levels in urine of kidney patients may predict risk of death

Patients with chronic kidney disease who have low ammonium excretion in their urine may be at high risk of disease progression or death, a new study warns.

Measuring ammonium excretion in the urine may be help identify patients with chronic kidney disease (CKD) who face serious health risks, researchers said.

Keeping the body’s pH level in balance is important for normal organ function. Doctors commonly assess whether a patient’s body fluids contain too much acid, a condition called acidosis, by measuring bicarbonate levels in the blood.

This can indicate whether the body is having trouble maintaining its acid-base balance, but it may reveal only part of the picture because the kidneys are important for eliminating acid in the urine.

Kalani Raphael from University of Utah in the US and colleagues looked to see if urine levels of ammonium may be a better indicator of acid accumulation in the body. Their analysis included 1,044 individuals with CKD in the African American Study of Kidney Diseases and Hypertension.

The researchers found that low urine ammonium excretion predicted kidney failure or death in CKD patients irrespective of serum bicarbonate concentration.

Compared with participants with the highest levels of daily ammonium excretion, those with the lowest levels had a 46 % higher risk of dying or needing dialysis, and those with intermediate levels had a 14% higher risk.

Low ammonium excretion predicted these outcomes even in patients who had normal serum bicarbonate. In addition, those with low ammonium excretion had a 2.6-fold higher risk of developing acidosis within one year.

“These results suggest that low urine ammonium excretion identifies individuals at high risk of CKD progression or death irrespective of the serum bicarbonate concentration,” said Raphael.

“Overall, acid levels in the urine provide important information about kidney health above and beyond acid measurements obtained from the blood,” Raphael said.

The study also suggests that CKD patients with low urine ammonium excretion might benefit from alkali before overt acidosis develops. The findings appear in the Journal of the American Society of Nephrology (JASN). 









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9 habits that may do more harm than good

1. Compulsively using hand sanitizer.

If you reach for hand sanitizer any time you make contact with the outside 

world, you might want to take pause. Unless you're in an especially germ-

prone place like a hospital, soap and water will work just fine. When you're 

not near a sink, hand sanitizing gels can help, but be sure to read the label 

first. Recent research has shown that those containing triclosan may promote 

bacteria and virus resistance to antibiotic medications (this goes for 

antibacterial hand soaps that contain triclosan, too). Instead, choose brands 

which contain at least 60% alcohol, which will kill 99% of bacteria on 

contact.

2. Experimenting with skincare products.

Who isn't tempted to buy the latest skin creams and serums promising to 

shed years from your face? While looking for something that works for you is a 

good idea, overhauling your routine every few weeks in search of the fountain 

of youth isn't. "Women get easily bored with their beauty routine, especially if 

they don't see results right away. It can take between six and eight weeks to 

see changes; if you're using a product to increase collagen, expect to wait six 

months to see results." A Dr. often cautions patients against constantly 

changing products, noting that it may cause adult rosacea (a condition that 

results in red, patchy and sometimes inflamed skin). People may be forming 

sensitive skin by trying out too many different products with high levels of 

fragrance and other sensitizers. In lieu of always trying something new, stick 

with what works for you, or see your dermatologist to develop a new routine. 

And manage your expectations, a consistent regime should "keep your skin 

clear, clean and smooth. Make that your rule of thumb and don't expect 

miracles, especially when it comes to over-the-counter anti- ageing products."

3. Wearing flip-flops.

Forgoing sky-high heels and toe-pinching boots for the freedom of flip-flops is 

giving your feet a much-need break, right? Not exactly. Turns out, your 

summer shoes aren't doing you any favours. "Flip-flops and other unsupported 

sandals, which have no arch support and give no structural support to the 

foot, can lead to stress fractures since your un-cushioned feet become 

strained when they try to support too much weight," she explains. "Extensor 

or flexor tendinitis is also a common problem that happens as a result of 

trying to keep your flip-flips on — the muscles on top or underneath your feet 

overexert themselves while trying to grip your shoes." She also advises 

against walking around shoeless, even if you're by the pool or in your gym's 

locker room. "Aside from not giving your feet any support, going barefoot can 

also be challenging for those prone to infectious skin diseases such as plantar 

warts and athlete's foot, which are easily spread poolside, in pedicure salons 

and in gyms." But that doesn't mean you need to spend your summer in 

closed toe shoes. Dr. recommends comfortable sandals that also provide 

plenty of support, like styles.

4. Brushing your teeth after every meal.

Rushing to brush immediately after every meal may seem like a great way to 

keep your oral health in check, but according to a periodontist, it's better to 

hold off. Food can leave acid on your teeth, which can weaken the enamel, 

"and brushing while the enamel is in a weakened state can actually scrub the 

enamel away." To dislodge any food particles that may remain after eating, 

he recommends simply rinsing your mouth out with water and saving the 

brushing for morning and night. Then when you do brush, be sure to do so in a 

circular motion. According to Dr., this will improve your chances of removing 

harmful bacteria between the teeth and gums. Brushing up and down or back 

and forth, on the other hand, can leave behind harmful bacteria, causing gum 

disease; while applying too much pressure can lead to receding gums.

5. Doing only cardio when you work out.

It's easy to assume that the best way to lose weight is to stick to the same 

cardio workout, but "if you only do cardio, your body will become so 

accustomed to the routine that you'll start to burn less fat over time," says a 

physical therapist. Plus, going through repeated motions on the treadmill or 

elliptical machine can create tight muscles and lead to injury. Trade in a few 

of your cardio workouts for circuit training, which involves doing a number of 

different strength training exercises with little rest between moves in order to 

keep your heart rate up while also working out your entire body, ensuring that 

you'll burn the most calories — without burning out. Integrating resistance 

training into your routine will create muscle mass, which will help you burn 

more calories throughout the day, even when you're at rest. It is also 

recommended revamping your cardio routine by mixing in interval training 

once a week. Try doing 30 seconds of high intensity motion, whether you're 

on the treadmill, elliptical machine or in the swimming pool, followed by 90 

seconds of recovery at a moderate pace, working your way up to 10 

repetitions. The bursts of intensity followed by recovery will effectively and 

efficiently blast calories and fat.

6. Skipping meals to "save up" for later.

For example, many women will hold off on eating lunch so that they can have 

a few glasses of wine to unwind at the end of the day. Not a problem as long 

as you're carefully allocating your calories, right? "Unfortunately when you 

don't eat breakfast or lunch you can develop cravings and irritability, which 

can lead to overeating later on in the day. A smarter approach to eating: Fill 

up on protein-packed meals and nutrient-rich snacks that'll keep your satisfied 

all day, so when dinnertime or cocktail hour rolls around you won't be tempted 

to fill your plate with calorie-rich and high-fat foods.

7. Drinking only bottled water.

By reaching for a bottle of H20 you may think you're doing your body some 

good by avoiding tap water, which can be filled with who-knows-what. But 

that's not the case. "Bottled water contains no fluoride, and we're seeing 

more and more adults suffer from a fluoride deficiency, which can lead to 

tooth decay," says Dr.  Instead, fill your glass with water purified by a  water 

filtration system which will keep your water free from impurities commonly 

found in tap water, but still allow you to reap the benefits of fluoride.

8. Cleaning with disinfecting products.

While keeping your home pristine and germ-free may seem like the path to 

perfect health, using cleansers that boast antibacterial or disinfecting 

properties could have the opposite effect. "These products haven't been 

proven to be any more effective than regular cleaning products, and there is 

significant evidence that the chemicals in these disinfecting cleansers — 

called quaternary ammonium compounds — can lead to asthma," says 

a senior scientist. Other cleaning product chemicals to avoid include 2-

butoxyethanol, which the Environmental Protection Agency considers a human 

carcinogen and has been linked to cancer; alkylphenol ethoxylates, which can 

disrupt hormones; and ethanolamines, which can cause asthma. But because 

cleaning product companies aren't required to list most ingredients on their 

product labels (you can call or go online instead), it can be tough to know 

what to buy. However, Seventh Generation, an eco-friendly company, clearly 

lists their ingredients on their labels, so that's one option. Another, which Dr. 

recommends, is cleaning with a mixture of one part water and one part 

vinegar, or scrubbing surfaces with baking soda, both of which have natural 

antibacterial properties. She emphasizes that when it comes to ousting 

germs, the key is cleaning often and thoroughly—not blasting every surface 

with the harshest cleaner you can find. "Your goal should be to clean 

regularly," says Dr. . "That way you'll get rid of dirt, so there's no place for 

bacteria to grow."

9. Loading up on nutritional supplements.

People often take nutritional supplements without really understanding what 

they're consuming, or if they really need them." Because so many foods are 

fortified these days, she notes that chances are many of us don't have any 

major nutritional deficiencies. If you are already getting enough of what you 

need, the best case scenario is that the supplements will have no effect on 

you. But there are more serious side effects of carelessly popping pills: 

Vitamin A in large amounts can be toxic to a developing foetus, vitamin C in 

large doses can cause gastrointestinal distress as well as interfere with 

glucose readings in people on diabetes medications and too much vitamin B6 

can cause nerve damage. It is now concluded that in the absence of a 

deficiency, eating food instead of taking supplements should be the primary 

way to fulfil nutritional requirements and deliver health benefits. If you find 

out that you need to up your intake of, say, calcium, "try integrating calcium-

rich foods into your diet, like a glass of skim milk or a spinach salad," before 

making a beeline to the supplements aisle. If you do learn that supplements 

are the best choice to remedy a deficiency, look for "USP" printed on the 

label, which signifies that the pill meets the standards of the testing 

organization U.S. Pharmacopeia.

ps- this is only for information, always consult you physician before having any particular food/ medication/exercise/other remedies.

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