Abstract: SA-PO0895
The 2025-2030 US Dietary Guidelines Inverted Pyramid and Mortality in CKD
Session Information
- Health Maintenance, Nutrition, and Metabolism
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Authors
- Gembillo, Guido, Universita degli Studi di Messina, Messina, Sicily, Italy
- Soraci, Luca, Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
- Corsonello, Andrea, Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
- Santoro, Domenico, Universita degli Studi di Messina, Messina, Sicily, Italy
Background
CKD affects roughly one in ten adults worldwide and carries substantial excess mortality. Several dietary patterns have been proposed for cardiometabolic protection, including DASH, the Mediterranean Diet, and the Planetary Health Diet (PHD). The Inverted Pyramid Diet, advanced within the 2025–2030 US Dietary Guidelines, accommodates higher animal-source and ultra-processed intake. Whether these patterns translate into different survival outcomes in CKD remains unsettled. We tested this in a harmonized multicohort framework.
Methods
We pooled CKD participants from NHANES 1999–2018 (n=5,847) and the 2013 Health Care and Nutrition Study within HRS (n=2,318), yielding 8,165 individuals with eGFR below 60 mL/min/1.73 m2 or albuminuria. Mean follow-up was 8.4 (SD 4.2) and 6.7 (SD 2.9) years. Adherence to DASH, Mediterranean, PHD, and Inverted Pyramid scores was derived from validated dietary recalls. Cox models, adjusted for age, sex, race or ethnicity, education, smoking, physical activity, BMI, diabetes, hypertension, prior CVD, and eGFR category, estimated all-cause and renal-related mortality. Estimates were pooled by random-effects meta-analysis.
Results
Baseline cancer prevalence was 14.2% (n=1,162), higher in those aged 70 or older (18.7% vs 9.3%, p<0.001). Over follow-up, 2,847 deaths accrued (34.9%), of which 312 were renal-related (3.8%). Per SD increase, the PHD showed the largest reduction in all-cause mortality (HR 0.83, 95% CI 0.78–0.89, p<0.001), followed by DASH (HR 0.88, 0.83–0.94) and Mediterranean (HR 0.90, 0.85–0.96). The Inverted Pyramid Diet moved in the opposite direction, HR 1.18 (1.10–1.27, p<0.001). Renal-related mortality mirrored these gradients: PHD HR 0.76 (0.64–0.90) and Inverted Pyramid HR 1.32 (1.12–1.56). Among 1,162 participants with prevalent cancer, the PHD retained a robust signal (HR 0.79, 0.68–0.92). Ultra-processed foods at 30% or more of energy added 24% to mortality risk; red meat at four or more servings weekly added 19%.
Conclusion
In CKD, a plant-forward diet built on minimally processed foods carried 17% lower mortality across two US cohorts. DASH and Mediterranean adherence yielded smaller but consistent benefits. The Inverted Pyramid Diet was tied to 18–32% higher mortality, driven by ultra-processed intake and red meat. Dietary guidance for CKD should prioritize plant-based composition over ultra-processed and animal-source predominance.