Kidney Week

Abstract: SA-PO812

Fewer Daily Fruit and Vegetable (FV) intake in Adults with CKD May Increase the Risk of ESRD

Session Information

• Health Maintenance, Nutrition, Metabolism - II
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1300 Health Maintenance, Nutrition, and Metabolism

Authors

• Banerjee, Tanushree, University of California San Francisco, San Francisco, California, United States

Tanushree Banerjee,

• Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden

Juan Jesus Carrero,

• McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States

Charles E. McCulloch,

• Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Nilka Rios Burrows,

• Siegel, Karen R., CDC, Atlanta, Georgia, United States

Karen R. Siegel,

• Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States

Hal Morgenstern,

• Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States

Rajiv Saran,

• Powe, Neil R., Priscilla Chan and Mark Zuckerberg San Francisco Gen Hosp & UCSF, San Francisco, California, United States

Neil R. Powe,

Background

Previous studies have examined the overall FV intake and the effect on CKD progression. However, the association between the number of servings of FVs per day with kidney functional decline is relatively unexplored. We examined the relation between daily number of servings of FV and risk of ESRD in adults with CKD stage 3 and 4.

Methods

We analyzed a cohort of 1084 adults with CKD stage 3-4 (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 for ESRD over a follow-up of 14 years. Daily FV servings were ascertained using a food frequency questionnaire. We examined the association between sex-specific quintiles for FV servings and incident ESRD using a Fine Gray competing risk model with age as time scale and cardiovascular mortality as the competing event. We adjusted for age, sex, socio-economic status (SES), total caloric intake, meat and fish intake, A1C, systolic BP, baseline eGFR, and urinary albumin–to-creatinine ratio (ACR).

Results

Mean age was 76.1 years; 47.8% were men. Those in quintile 1 (fewest servings of FV per day) were more likely to have lower SES; those in highest quintile (most servings of FV per day) were more likely to have DM and hypertension. 120 participants (11.1%) developed ESRD during follow-up. Compared to quintile 5, those in lowest quintiles had a greater risk of ESRD--for quintile 4: relative hazard [RH, 95% CI] = 1.07[0.84-1.40], for quintile 3: 1.11[0.89-1.36], for quintile 2: 1.56[1.18-1.98] and for quintile 1: 1.39[1.10-1.72]. Sex modified the estimated effect of FV quintile (p-interaction=0.03), the RH for the lowest vs highest quintile was (2.10[1.71-2.64]) for women and (1.24[0.90-1.57]) for men.

Conclusion

Fewer servings of FVs per day, with a threshold value corresponding to servings less than quintile 3 (<4.5 servings/day in men and women), is independently associated with a higher risk of ESRD. Since dietary restrictions in the setting of CKD result in a lower intake of FVs, a randomized trial to evaluate potential benefits and harms of higher FV servings may provide guidance for effective dietary recommendations.

Funding

• Other U.S. Government Support