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

• 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
• Journal Title: American Journal of Kidney Diseases
• Volume: Volume 64, Number 2
• Publisher: Elsevier: 12 months | 2014-01-01, Pages 204-213
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1053/j.ajkd.2014.02.013
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• 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

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.