Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study.

Academic Article

Abstract

  • BACKGROUND: Nutrition is linked strongly with health outcomes in chronic kidney disease (CKD). However, few studies have examined relationships between dietary patterns and health outcomes in persons with CKD. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 3,972 participants with CKD (defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-creatinine ratio ≥ 30 mg/g at baseline) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a prospective cohort study of 30,239 black and white adults at least 45 years of age. PREDICTORS: 5 empirically derived dietary patterns identified by factor analysis: "convenience" (Chinese and Mexican foods, pizza, and other mixed dishes), "plant-based" (fruits and vegetables), "sweets/fats" (sugary foods), "Southern" (fried foods, organ meats, and sweetened beverages), and "alcohol/salads" (alcohol, green-leafy vegetables, and salad dressing). OUTCOMES: All-cause mortality and end-stage renal disease (ESRD). RESULTS: 816 deaths and 141 ESRD events were observed over approximately 6 years of follow-up. There were no statistically significant associations of convenience, sweets/fats, or alcohol/salads pattern scores with all-cause mortality after multivariable adjustment. In Cox regression models adjusted for sociodemographic factors, energy intake, comorbid conditions, and baseline kidney function, higher plant-based pattern scores (indicating greater consistency with the pattern) were associated with lower risk of mortality (HR comparing fourth to first quartile, 0.77; 95% CI, 0.61-0.97), whereas higher Southern pattern scores were associated with greater risk of mortality (HR comparing fourth to first quartile, 1.51; 95% CI, 1.19-1.92). There were no associations of dietary patterns with incident ESRD in multivariable-adjusted models. LIMITATIONS: Missing dietary pattern data, potential residual confounding from lifestyle factors. CONCLUSIONS: A Southern dietary pattern rich in processed and fried foods was associated independently with mortality in persons with CKD. In contrast, a diet rich in fruits and vegetables appeared to be protective.
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    Keywords

  • Dietary pattern, chronic kidney disease (CKD), disease progression, kidney failure, modifiable risk factor, mortality risk, nutrition, Aged, Cohort Studies, Disease Progression, Feeding Behavior, Female, Follow-Up Studies, Humans, Kidney Failure, Chronic, Male, Middle Aged, Population Surveillance, Prospective Studies, Renal Insufficiency, Chronic, Risk Factors
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    Author List

  • Gutiérrez OM; Muntner P; Rizk DV; McClellan WM; Warnock DG; Newby PK; Judd SE
  • Start Page

  • 204
  • End Page

  • 213
  • Volume

  • 64
  • Issue

  • 2