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Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones.
Clin J Am Soc Nephrol 2016; 11(10):1834-1844CJ

Abstract

BACKGROUND AND OBJECTIVES

Protein and potassium intake and the resulting diet-dependent net acid load may affect kidney stone formation. It is not known whether protein type or net acid load is associated with risk of kidney stones.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We prospectively examined intakes of protein (dairy, nondairy animal, and vegetable), potassium, and animal protein-to-potassium ratio (an estimate of net acid load) and risk of incident kidney stones in the Health Professionals Follow-Up Study (n=42,919), the Nurses' Health Study I (n=60,128), and the Nurses' Health Study II (n=90,629). Multivariable models were adjusted for age, body mass index, diet, and other factors. We also analyzed cross-sectional associations with 24-hour urine (n=6129).

RESULTS

During 3,108,264 person-years of follow-up, there were 6308 incident kidney stones. Dairy protein was associated with lower risk in the Nurses' Health Study II (hazard ratio for highest versus lowest quintile, 0.84; 95% confidence interval, 0.73 to 0.96; P value for trend <0.01). The hazard ratios for nondairy animal protein were 1.15 (95% confidence interval, 0.97 to 1.36; P value for trend =0.04) in the Health Professionals Follow-Up Study and 1.20 (95% confidence interval, 0.99 to 1.46; P value for trend =0.06) in the Nurses' Health Study I. Potassium intake was associated with lower risk in all three cohorts (hazard ratios from 0.44 [95% confidence interval, 0.36 to 0.53] to 0.67 [95% confidence interval, 0.57 to 0.78]; P values for trend <0.001). Animal protein-to-potassium ratio was associated with higher risk (P value for trend =0.004), even after adjustment for animal protein and potassium. Higher dietary potassium was associated with higher urine citrate, pH, and volume (P values for trend <0.002).

CONCLUSIONS

Kidney stone risk may vary by protein type. Diets high in potassium or with a relative abundance of potassium compared with animal protein could represent a means of stone prevention.

Authors+Show Affiliations

Division of Nephrology, Fondazione Policlinico Universitario "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy; pietromanuel.ferraro@unicatt.it.Renal Division, Department of Medicine and.Renal Division, Department of Medicine and. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.Division of Nephrology, Fondazione Policlinico Universitario "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and. Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27445166

Citation

Ferraro, Pietro Manuel, et al. "Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones." Clinical Journal of the American Society of Nephrology : CJASN, vol. 11, no. 10, 2016, pp. 1834-1844.
Ferraro PM, Mandel EI, Curhan GC, et al. Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones. Clin J Am Soc Nephrol. 2016;11(10):1834-1844.
Ferraro, P. M., Mandel, E. I., Curhan, G. C., Gambaro, G., & Taylor, E. N. (2016). Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones. Clinical Journal of the American Society of Nephrology : CJASN, 11(10), pp. 1834-1844. doi:10.2215/CJN.01520216.
Ferraro PM, et al. Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones. Clin J Am Soc Nephrol. 2016 10 7;11(10):1834-1844. PubMed PMID: 27445166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones. AU - Ferraro,Pietro Manuel, AU - Mandel,Ernest I, AU - Curhan,Gary C, AU - Gambaro,Giovanni, AU - Taylor,Eric N, Y1 - 2016/07/21/ PY - 2016/02/10/received PY - 2016/06/20/accepted PY - 2016/7/23/pubmed PY - 2017/12/2/medline PY - 2016/7/23/entrez KW - Body Mass Index KW - Citrates KW - Citric Acid KW - Cross-Sectional Studies KW - Diet KW - Dietary Proteins KW - Epidemiologic Studies KW - Follow-Up Studies KW - Kidney Calculi KW - NEAP KW - Potassium, Dietary KW - Risk KW - Vegetables KW - acid load KW - kidney stones KW - nutrition KW - potassium KW - protein KW - urolithiasis SP - 1834 EP - 1844 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 11 IS - 10 N2 - BACKGROUND AND OBJECTIVES: Protein and potassium intake and the resulting diet-dependent net acid load may affect kidney stone formation. It is not known whether protein type or net acid load is associated with risk of kidney stones. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We prospectively examined intakes of protein (dairy, nondairy animal, and vegetable), potassium, and animal protein-to-potassium ratio (an estimate of net acid load) and risk of incident kidney stones in the Health Professionals Follow-Up Study (n=42,919), the Nurses' Health Study I (n=60,128), and the Nurses' Health Study II (n=90,629). Multivariable models were adjusted for age, body mass index, diet, and other factors. We also analyzed cross-sectional associations with 24-hour urine (n=6129). RESULTS: During 3,108,264 person-years of follow-up, there were 6308 incident kidney stones. Dairy protein was associated with lower risk in the Nurses' Health Study II (hazard ratio for highest versus lowest quintile, 0.84; 95% confidence interval, 0.73 to 0.96; P value for trend <0.01). The hazard ratios for nondairy animal protein were 1.15 (95% confidence interval, 0.97 to 1.36; P value for trend =0.04) in the Health Professionals Follow-Up Study and 1.20 (95% confidence interval, 0.99 to 1.46; P value for trend =0.06) in the Nurses' Health Study I. Potassium intake was associated with lower risk in all three cohorts (hazard ratios from 0.44 [95% confidence interval, 0.36 to 0.53] to 0.67 [95% confidence interval, 0.57 to 0.78]; P values for trend <0.001). Animal protein-to-potassium ratio was associated with higher risk (P value for trend =0.004), even after adjustment for animal protein and potassium. Higher dietary potassium was associated with higher urine citrate, pH, and volume (P values for trend <0.002). CONCLUSIONS: Kidney stone risk may vary by protein type. Diets high in potassium or with a relative abundance of potassium compared with animal protein could represent a means of stone prevention. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/27445166/Dietary_Protein_and_Potassium_Diet_Dependent_Net_Acid_Load_and_Risk_of_Incident_Kidney_Stones_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=27445166 DB - PRIME DP - Unbound Medicine ER -