Poor accordance to a DASH dietary pattern is associated with higher risk of ESRD among adults with moderate chronic kidney disease and hypertension

• Published in: Kidney international Vol. 95; no. 6; pp. 1433 - 1442
• Main Authors: Banerjee, Tanushree, Crews, Deidra C., Tuot, Delphine S., Pavkov, Meda E., Burrows, Nilka Rios, Stack, Austin G., Saran, Rajiv, Bragg-Gresham, Jennifer, Powe, Neil R., Powe, Neil, Tuot, Delphine, Hsu, Chi-yuan, McCulloch, Charles, Crews, Deidra, Hsu, Raymond, Grubbs, Vanessa, Bibbins-Domingo, Kirsten, Shlipak, Michael, Peralta, Carmen, Rubinsky, Anna, Coresh, Josef, Shahinian, Vahakn, Gillespie, Brenda, Morgenstern, Hal, Heung, Michael, Herman, William, McClellan, William, Steffick, Diane, Tilea, Anca, Yin, Maggie, Robinson, Ian, Zivin, Kara, Kurtz, Vivian, Wyncott, April, Burrows, Nilka Ríos, Eberhardt, Mark, Geiss, Linda, Mondesire, Juanita, Moore, Bernice, Patel, Priti, Pavkov, Meda, Rolka, Deborah, Saydah, Sharon, Shrestha, Sundar, Waller, Larry
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019
• Subjects: Aged; Aged, 80 and over; Blood Pressure; CKD; diabetes; diet; Dietary Approaches To Stop Hypertension - statistics & numerical data; Disease Progression; ESRD; Female; Glomerular Filtration Rate; Humans; Hypertension - drug therapy; Hypertension - etiology; Incidence; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - pathology; Kidney Failure, Chronic - prevention & control; Male; Middle Aged; Nutrition Surveys - statistics & numerical data; Patient Compliance - statistics & numerical data; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diet therapy; Renal Insufficiency, Chronic - pathology; Risk Factors; ESRD; diet; CKD; diabetes
• ISSN: 0085-2538; 1523-1755; 1523-1755
• DOI: 10.1016/j.kint.2018.12.027

The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure, an important risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, it is unclear whether adherence to a DASH diet confers protection against future ESRD, especially among those with pre-existing CKD and hypertension. We examined whether a DASH diet is associated with lower risk of ESRD among 1,110 adults aged ≥ 20 years with hypertension and CKD (estimated glomerular filtration rate, eGFR 30-59 ml/min/1.73 m2) enrolled in the National Health and Nutrition Examination Survey (1988-1994). Baseline DASH diet accordance score was assessed using a 24-hour dietary recall questionnaire. ESRD was ascertained by linkage to the U.S. Renal Data System registry. We used the Fine-Gray competing risks method to estimate the relative hazard (RH) for ESRD after adjusting for sociodemographics, clinical and nutritional factors, eGFR, and albuminuria. Over a median follow-up of 7.8 years, 18.4% of subjects developed ESRD. Compared to the highest quintile of DASH diet accordance, there was a greater risk of ESRD among subjects in quintiles 1 (RH=1.7; 95% CI 1.1-2.7) and 2 (RH 2.2; 95% CI 1.1-4.1). Significant interactions were observed with diabetes status and race/ethnicity, with the strongest association between DASH diet adherence and ESRD risk observed in individuals with diabetes and in non-Hispanic blacks. Low accordance to a DASH diet is associated with greater risk of ESRD in adults with moderate CKD and hypertension, particularly in non-Hispanic blacks and persons with diabetes. [Display omitted]