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

• Type of Material: Article
• Authors: Orlando M. Gutiérrez, University of Alabama Birmingham; Paul Muntner, University of Alabama Birmingham; Dana V. Rizk, University of Alabama Birmingham; William McClellan, Emory University; David G. Warnock, University of Alabama Birmingham; P. K. Newby, Boston University; Suzanne E. Judd, TUniversity of Alabama Birmingham
• Language: English
• Date: 2014-01-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 by the National Kidney Foundation, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1053/j.ajkd.2014.02.013
• Title of Journal or Parent Work: American Journal of Kidney Diseases
• ISSN: 0272-6386
• Volume: 64
• Issue: 2
• Start Page: 204
• End Page: 213
• Grant/Funding Information: Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Corporation.; OMG was supported by NIH grants K23DK081673 (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]); R03DK095005 (NIDDK); and R01NS080850 (NINDS).; 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).
• Keywords: Dietary pattern; Follow-Up Studies; Prospective Studies; Humans; kidney failure; Cohort Studies; Population Surveillance; mortality risk; Risk Factors; Renal Insufficiency, Chronic; disease progression; Female; nutrition; Middle Aged; chronic kidney disease (CKD); Male; Disease Progression; Feeding Behavior; modifiable risk factor; Aged; Kidney Failure, Chronic
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

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 m 2 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.