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Abstract: FR-OR124

Pro-Inflammatory Diets Increase Risk of ESRD in US Adults with CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical


  • Banerjee, Tanushree, University of California, San Francisco, California, United States
  • Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States
  • Powe, Neil R., Priscilla Chan and Mark Zuckerberg San Francisco Gen Hosp & UCSF, San Francisco, California, United States

CKD progression can be accompanied by chronic low-grade inflammation marked by elevated concentrations of inflammatory markers. We hypothesized that proinflammatory diets increase risk of kidney disease progression and systemic inflammation is a mediator of progression of kidney disease.


We analyzed a cohort study of 1084 adults with CKD (eGFR 15-59 ml/min/1.73m2) aged≥ 20 years in the 1988-1994 National Health and Nutrition Examination Survey linked with the US Renal Data System, allowing for assessment of ESRD as an outcome over a follow-up period of 14 years. The Adapted Dietary Inflammatory Index (ADII, based on 26 components) was calculated at baseline from a 24-hr dietary recall. We used regression analysis to examine the association between ADII and an inflammatory score (IS) computed from C-reactive protein, serum albumin, white blood cell count, and mean platelet volume, adjusting for demographics, body mass index, physical activity, HbA1C, systolic blood pressure, total cholesterol. The Fine Gray competing risk model was used for exploring the association between (i) IS and ESRD, and (ii) risk of incident ESRD and per standard deviation (SD) increase in ADII. The models were adjusted for the above mentioned covariates and estimated glomerular filtration rate and urinary albumin–to-creatinine ratio (ACR). IS was considered as a mediator of CKD progression using Valeri and Vanderweele’s method.


120 participants with CKD (11.1%) developed ESRD. A 1 SD increase in ADII was associated with a higher IS (β [95% CI]: 1.05[0.89-1.22]). IS was also associated with ESRD (relative hazard [RH]: 1.12 [95% CI: 1.02-1.25]). ADII was associated with increased risk of incident ESRD (RH per SD increase: 1.40 [1.04-1.78]). Mediation analyses showed that 25% of the total effect of the ADII on ESRD was explained or mediated by IS. Interaction tests showed a higher risk of ESRD per SD increase in ADII in adults with ACR≥30mg/g (RH 1.55 [1.12-1.96] than those with ACR<30 mg/g (RH 0.96 [0.55-1.38]; pinteraction<0.001).


A proinflammatory diet is independently associated with risk of ESRD which is mediated by the inflammatory markers. These findings have implications for prevention of ESRD using dietary approaches.


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