Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study

Valerie K Sullivan; Lawrence J Appel; Cheryl A M Anderson; Hyunju Kim; Mark L Unruh; James P Lash; Marsha Trego; James Sondheimer; Mirela Dobre; Nishigandha Pradhan; Panduranga S Rao; Jing Chen; Jiang He; Casey M Rebholz; CRIC Study Investigators

doi:10.1053/j.ajkd.2023.01.452

Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study

Am J Kidney Dis. 2023 Apr 6;S0272-6386(23)00585-1. doi: 10.1053/j.ajkd.2023.01.452. Online ahead of print.

Authors

Collaborators

CRIC Study Investigators:
Debbie L Cohen, Harold I Feldman, Alan S Go, Robert G Nelson, Mahboob Rahman, Vallabh O Shah

Affiliations

¹ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California.
⁴ Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM.
⁵ Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, IL.
⁶ Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
⁷ Division of Nephrology and Hypertension, School of Medicine, Wayne State University, Detroit, MI.
⁸ Department of Medicine (Nephrology), Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH.
⁹ Division of Nephrology, University of Michigan, Ann Arbor, MI.
¹⁰ Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
¹¹ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
¹² Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: crebhol1@jhu.edu.

PMID: 37028638
DOI: 10.1053/j.ajkd.2023.01.452

Abstract

Rationale & objective: Ultraprocessed foods are widely consumed in the United States and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the general population. We investigated associations between ultraprocessed food intake and chronic kidney disease (CKD) progression, all-cause mortality, and incident CVD in adults with chronic kidney disease (CKD).

Study design: Prospective cohort study.

Setting & participants: Chronic Renal Insufficiency Cohort Study participants who completed baseline dietary questionnaires.

Exposure: Ultraprocessed food intake (in servings per day) classified according to the NOVA system.

Outcomes: CKD progression (≥50% decrease in estimated glomerular filtration rate [eGFR] or initiation of kidney replacement therapy), all-cause mortality, and incident CVD (myocardial infarction, congestive heart failure, or stroke).

Analytical approach: Cox proportional hazards models adjusted for demographic, lifestyle, and health covariates.

Results: There were 1,047 CKD progression events observed during a median follow-up of 7 years. Greater ultraprocessed food intake was associated with higher risk of CKD progression (tertile 3 vs tertile 1, HR, 1.22; 95% CI, 1.04-1.42; P=0.01 for trend). The association differed by baseline kidney function, such that greater intake was associated with higher risk among people with CKD stages 1/2 (eGFR≥60mL/min/1.73m²; tertile 3 vs tertile 1, HR, 2.61; 95% CI, 1.32-5.18) but not stages 3a-5 (eGFR<60mL/min/1.73m²; P=0.003 for interaction). There were 1,104 deaths observed during a median follow-up of 14 years. Greater ultraprocessed food intake was associated with higher risk of mortality (tertile 3 vs tertile 1, HR, 1.21; 95% CI, 1.04-1.40; P=0.004 for trend).

Limitations: Self-reported diet.

Conclusions: Greater ultraprocessed food intake may be associated with CKD progression in earlier stages of CKD and is associated with higher risk of all-cause mortality in adults with CKD.

Keywords: CRIC Study; NOVA; dietary intake; epidemiology; kidney disease; nutrition; ultraprocessed foods.