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

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. (C) 2014 by the National Kidney Foundation, Inc.