Dietary Patterns and Risk of Death and Progression to ESRD in Individuals With CKD: A Cohort Study

doi:10.1053/j.ajkd.2014.02.013

American Journal of Kidney Diseases

Volume 64, Issue 2, August 2014, Pages 204-213

https://doi.org/10.1053/j.ajkd.2014.02.013 Get rights and content

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.

Section snippets

Study Population and Participants

The REGARDS Study is a population-based investigation of stroke incidence in black and white US adults 45 years or older. Details of the study design have been reviewed elsewhere.¹⁴ Briefly, the study was designed to provide approximately equal representation of men and women and oversampled individuals who were black, as well as individuals living in 8 Southeastern US states that have disproportionately higher stroke mortality than the rest of the United States, termed the “stroke buckle”

Study Participants

In general, higher consumption of the convenience and alcohol/salads dietary patterns (defined by greater proportion of participants in the fourth quartile as compared to the first) was associated with younger age, white race, male sex, higher income, and residence outside the Southeastern United States (Table 1). Higher consumption of the plant-based dietary pattern was associated with older age, black race, female sex, and residence within the Southeastern United States. Higher consumption of

Discussion

In participants with CKD from this large national cohort, higher scores for a dietary pattern characterized by fried foods, organ meats, and sweetened beverages—foods commonly found in Southern cuisines—were associated independently with higher risk of mortality. In contrast, higher consumption of a diet rich in fish, fruits, and vegetables was associated with lower mortality risk over time.

Prior studies have reported associations of dietary patterns with indexes of kidney health. A

Acknowledgements

The authors thank the other investigators, staff, and participants in the REGARDS Study for valuable contributions. A full list of participating REGARDS investigators and institutions can be found at www.regardsstudy.org.

Support: This study was supported by a cooperative agreement (grant U01 NS041588) from the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH). Dr Gutiérrez was supported by NIH grants K23DK081673 (National Institute of Diabetes

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View full text

Original InvestigationPathogenesis and Treatment of Kidney DiseaseDietary Patterns and Risk of Death and Progression to ESRD in Individuals With CKD: A Cohort Study

Background

Study Design

Setting & Participants

Predictors

Outcomes

Results

Limitations

Conclusions

Section snippets

Study Population and Participants

Study Participants

Discussion

Acknowledgements

Kidney Int

Kidney Int

Am J Kidney Dis

Kidney Int

Am J Clin Nutr

J Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Kidney Dis

Am J Prev Med

Ann Epidemiol

Kidney Int

Original Investigation
Pathogenesis and Treatment of Kidney Disease
Dietary Patterns and Risk of Death and Progression to ESRD in Individuals With CKD: A Cohort Study