Kidney Week

Abstract: FR-PO1076

Association Between the Planetary Health Diet and Incident CKD in the Atherosclerosis Risk in Communities (ARIC) Study

Session Information

• Health Maintenance, Nutrition, and Metabolism
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Girma, Dawit E, Brown University, Providence, Rhode Island, United States

Dawit E Girma

• Yang, Jiaqi, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Jiaqi Yang, ScM

• Bernard, Lauren, University of Maryland School of Medicine, Baltimore, Maryland, United States

Lauren Bernard, MS

• Sullivan, Valerie, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Valerie Sullivan, PhD, RDN

• Kim, Hyunju, University of Washington School of Public Health, Seattle, Washington, United States

Hyunju Kim, PhD, MPH

• Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States

Morgan Grams, MD, PhD

• Rebholz, Casey, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Casey Rebholz, MS, PhD, MPH

Background

The Planetary Health Diet Index (PHDI) integrates diet quality and environmental sustainability, yet studies examining its association with chronic kidney disease (CKD) in U.S. adults are lacking.

Methods

Among 14,402 ARIC study participants free of CKD, dietary intake was assessed using a validated 66-item food-frequency questionnaire at visits 1 (1987-1989) and 3 (1993-95). The PHDI (range: 0–135) comprised 7 adequacy and 7 moderation components. Incident CKD was defined by (1) estimated glomerular filtration rate <60 mL/min/1.73 m² with ≥25% decline; (2) CKD-related ICD-9/10 codes; or (3) linkage with the US Renal Data System. Cox proportional-hazards models, adjusted for sociodemographic, lifestyle, and clinical factors, estimated hazard ratios (HRs) across PHDI quintiles and per 20-point increment; non-linearity was tested with restricted cubic splines (Figure 1).

Results

Over a median follow-up of 24 years, 5,152 (35.8%) incident CKD cases occurred. Participants in quintile 5 had a 12% lower CKD risk compared to quintile 1 (HR: 0.88; 95% CI: 0.80, 0.96). Each 20-point higher in PHDI was associated with a 12% lower CKD risk (HR: 0.88; 95% CI: 0.83, 0.94). There was an approximately linear relationship between PHDI and incident CKD. Higher index scores for nuts (HR: 0.85; 95% CI: 0.78, 0.93), non-soy legumes (HR: 0.88; 95% CI: 0.80, 0.97), whole grains (HR: 0.90; 95% CI: 0.82, 0.98), and red/processed meat (reflecting lower intake) (HR 0.75, 95 % CI: 0.68, 0.83) were inversely associated with risk of incident CKD.

Conclusion

Greater adherence to the Planetary Health Diet was associated with lower risk of incident CKD in this large, diverse cohort, supporting plant-forward, sustainable diets for kidney health.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20253qwfvgpk