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

Am J Kidney Dis. 2014 Aug;64(2):204-13. doi: 10.1053/j.ajkd.2014.02.013. Epub 2014 Mar 27.


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.

Keywords: Dietary pattern; chronic kidney disease (CKD); disease progression; kidney failure; modifiable risk factor; mortality risk; nutrition.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cohort Studies
  • Disease Progression*
  • Feeding Behavior* / physiology
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / diagnosis*
  • Kidney Failure, Chronic / diet therapy
  • Kidney Failure, Chronic / mortality*
  • Male
  • Middle Aged
  • Population Surveillance / methods
  • Prospective Studies
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / diet therapy
  • Renal Insufficiency, Chronic / mortality
  • Risk Factors