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Abstract: PO2242

Dietary Inflammatory Potential and the Risk of Incident ESKD in the Women's Health Initiative

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Johns, Tanya S., Albert Einstein College of Medicine, Bronx, New York, United States
  • Mossavar-Rahmani, Yasmin, Albert Einstein College of Medicine, Bronx, New York, United States
  • Hebert, James R., University of South Carolina, Columbia, South Carolina, United States
  • Franceschini, Nora, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Melamed, Michal L., Albert Einstein College of Medicine, Bronx, New York, United States
Background

Inflammation is implicated in the pathogenesis and progression of chronic kidney disease (CKD). Diet is an important modulator of chronic inflammation, and possibly kidney health. We evaluated the association of diet-associated inflammation with risk of incident end-stage kidney disease (ESKD) in the Women’s Health Initiative (WHI) study.

Methods

Participants enrolled between 1993-1998 in the Observational Study and Dietary Modification Trial of the WHI with completed food frequency questionnaires (FFQs), Medicare enrollment data, and serum creatinine (sCr) measurements were included in our study. Dietary inflammatory potential was assessed from FFQs using the dietary inflammatory index (DII®). The index has been previously validated in the WHI. Medicare claims data were used to ascertain ESKD status. Analyses used DII® scores adjusted for energy-intake (E-DII®), which were categorized into quartiles (Q): scores in Q1 (reference group) having the lowest dietary inflammatory potential and Q4 being the most pro-inflammatory. We performed multivariable Cox proportional hazards models adjusted for important covariates of interest to compare dietary quartiles for risk of incident ESKD. Participants were censored at the time of study withdrawal, loss-to-follow-up, or death.

Results

Of the 15,722 women included in our study, the mean age was 64.2 years (standard deviation 7.01); 35% self-identified as African American, 12% as Hispanic/Latinx, and 50% as White; 40% had hypertension and 9% had diabetes mellitus at baseline. The mean baseline sCr and estimated glomerular filtration rate were 0.74 mg/dL and 89 ml/min/1.73m2, respectively. African American and Hispanic women compared to White women (30% vs 19%) were more likely to report consuming diets with scores in Q4. Over mean follow-up of 11.5 years, 515 women developed ESKD. Women with dietary patterns in Q4 compared to those in Q1 had a 20% higher risk of developing ESKD (hazard ratio 1.20 [95% confidence interval 1.05 – 1.38]; P=0.02) after adjusting for age, race/ ethnicity, comorbidities, body mass index, education, medications, trial vs cohort study status, and region.

Conclusion

A pro-inflammatory dietary pattern is associated with a higher risk of new-onset ESKD among Medicare-eligible post-menopausal women without baseline CKD.