DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease

Abstract

Background: There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention. Evidence is lacking for effective dietary patterns for kidney disease prevention.

Study design: Prospective cohort study.

Setting & participants: Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60mL/min/1.73m² (N=14,882).

Predictor: The Dietary Approaches to Stop Hypertension (DASH) diet score was calculated based on self-reported dietary intake of red and processed meat, sweetened beverages, sodium, fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy products, averaged over 2 visits.

Outcomes: Cases were ascertained based on the development of eGFRs<60mL/min/1.73m² accompanied by ≥25% eGFR decline from baseline, an International Classification of Diseases, Ninth/Tenth Revision code for a kidney disease-related hospitalization or death, or end-stage renal disease from baseline through 2012.

Results: 3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile (HR, 1.16; 95% CI, 1.07-1.26; P for trend < 0.001), after adjusting for sociodemographics, smoking status, physical activity, total caloric intake, baseline eGFR, overweight/obese status, diabetes status, hypertension status, systolic blood pressure, and antihypertensive medication use. Of the individual components of the DASH diet score, high red and processed meat intake was adversely associated with kidney disease and high nuts, legumes, and low-fat dairy products intake was associated with reduced risk for kidney disease.

Limitations: Potential measurement error due to self-reported dietary intake and lack of data for albuminuria.

Conclusions: Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics, established kidney risk factors, and baseline kidney function. Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention.

Keywords: Chronic kidney disease (CKD); DASH diet score; diet; dietary acid load; dietary protein; disease progression; food frequency questionnaire; health promotion; incident kidney disease; kidney disease prevention; modifiable risk factor; renal function.

Figure 1

Risk^a of Kidney Disease for Low (Tertile 1) vs. High (Tertile 3) DASH Diet Score According to Demographic, Socioeconomic, and Clinical Characteristics ^a Hazard ratios for kidney disease are presented for the low (tertile 1) vs. high (tertile 3) DASH diet score, adjusted for age, sex, race-center, education level, smoking status, physical activity, total caloric intake, baseline eGFR (linear spline terms with one knot at 90 mL/min/1.73 m²), overweight/obese status, diabetes, hypertension, systolic blood pressure, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers