Primary Contributors to Dietary Acid Load in Patients With Urolithiasis

  • Melanie V. Betz
    Address correspondence to Melanie V. Betz, MS, RD, Chronic Kidney Disease Nutrition & Education Specialist, Section of Nephrology, University of Chicago Medicine, 5841 S. Maryland Ave; MC5100; Chicago, IL 60637.
    Chronic Kidney Disease Nutrition & Education Specialist, Section of Nephrology, University of Chicago Medicine, Chicago, IL
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  • Kristina L. Penniston
    Senior Scientist, University of Wisconsin School of Medicine and Public Health, Department of Urology; and Clinical Nutritionist, UW Health University Hospital and Clinics, Madison, WI
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      In susceptible individuals, high dietary acid load may contribute to the formation of certain types of kidney stones via lowering urine pH and citrate excretion. The objective of this study is to determine the contribution of dietary acid from food groups in people with urolithiasis.

      Design and Methods

      Patients with calcium urolithiasis (n = 83) who completed food records were used for this retrospective analysis. Descriptive statistics were calculated for nutrients, potential renal acid load (PRAL), and estimated net endogenous acid production (NEAPest). Pearson’s correlations were calculated between PRAL and NEAPest with each nutrient.


      Data from a total of 83 patients were used. Average PRAL was positively correlated with energy (r = 0.260, P = .02), total protein (r = 0.463, P < .001), animal protein (r = 0.555, P < .001), total fat (P = .399, P < .001), sodium (r = 0.385, P < .001), and phosphorus (r = 0.345, P < .001) intake. PRAL was negatively correlated with fiber (r = −0.246, P = .03) intake. NEAPest was positively correlated with total protein (r = 0.269, P = .01), animal protein (r = 0.377, P < .001), fat (r = 0.222, P = .04), and sodium (r = 0.250, P = .02) intake. NEAPest was negatively correlated with fiber (r = −0.399, P < .001), potassium (r = −0.360, P < .001), and magnesium (r = −0.233, P = .03) intake. For PRAL, meat contributed the highest acid load (52.7%), followed by grains (19.6%) and combination foods (19.6%). Beverages contributed the greatest alkali load (35.1%), followed by vegetables (30.6%) and fruits (28.6%). For NEAPest, cheese contributed the highest acid load (21.8%), followed by grains (19.3%) and meat (18.1%).


      For individuals with urolithiasis promoted by acidic urine and/or low urine citrate, dietary patterns with a high dietary acid load may contribute to recurrence risk. Meat and grains were the major contributors to dietary acid load in this cohort of patients with a history of kidney stones, whereas beverages, fruits, and vegetables contributed net alkali.
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