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. 2018 Jun;29(6):1741-1751.
doi: 10.1681/ASN.2018010008. Epub 2018 Apr 25.

The Association of Mediterranean and DASH Diets with Mortality in Adults on Hemodialysis: The DIET-HD Multinational Cohort Study

Valeria M Saglimbene  1   2 , Germaine Wong  3   4   5 , Jonathan C Craig  3   4 , Marinella Ruospo  2   6 , Suetonia C Palmer  7 , Katrina Campbell  8 , Vanessa Garcia-Larsen  9 , Patrizia Natale  2   10 , Armando Teixeira-Pinto  3   4 , Juan-Jesus Carrero  11 , Peter Stenvinkel  12 , Letizia Gargano  2 , Angelo M Murgo  2 , David W Johnson  13   14 , Marcello Tonelli  15 , Rubén Gelfman  2 , Eduardo Celia  2 , Tevfik Ecder  2 , Amparo G Bernat  2 , Domingo Del Castillo  2 , Delia Timofte  2 , Marietta Török  2 , Anna Bednarek-Skublewska  2   16 , Jan Duława  2   17 , Paul Stroumza  2 , Susanne Hoischen  2 , Martin Hansis  2 , Elisabeth Fabricius  2 , Paolo Felaco  18 , Charlotta Wollheim  2 , Jörgen Hegbrant  2 , Giovanni F M Strippoli  3   2   10   19
Affiliations

The Association of Mediterranean and DASH Diets with Mortality in Adults on Hemodialysis: The DIET-HD Multinational Cohort Study

Valeria M Saglimbene et al. J Am Soc Nephrol. 2018 Jun.

Abstract

Background Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardiovascular and all-cause mortality in the general population, but the benefits for patients on hemodialysis are uncertain.Methods Mediterranean and DASH diet scores were derived from the GA2LEN Food Frequency Questionnaire within the DIET-HD Study, a multinational cohort study of 9757 adults on hemodialysis. We conducted adjusted Cox regression analyses clustered by country to evaluate the association between diet score tertiles and all-cause and cardiovascular mortality (the lowest tertile was the reference category).Results During the median 2.7-year follow-up, 2087 deaths (829 cardiovascular deaths) occurred. The adjusted hazard ratios (95% confidence intervals) for the middle and highest Mediterranean diet score tertiles were 1.20 (1.01 to 1.41) and 1.14 (0.90 to 1.43), respectively, for cardiovascular mortality and 1.10 (0.99 to 1.22) and 1.01 (0.88 to 1.17), respectively, for all-cause mortality. Corresponding estimates for the same DASH diet score tertiles were 1.01 (0.85 to 1.21) and 1.19 (0.99 to 1.43), respectively, for cardiovascular mortality and 1.03 (0.92 to 1.15) and 1.00 (0.89 to 1.12), respectively, for all-cause mortality. The association between DASH diet score and all-cause death was modified by age (P=0.03); adjusted hazard ratios for the middle and highest DASH diet score tertiles were 1.02 (0.81 to 1.29) and 0.70 (0.53 to 0.94), respectively, for younger patients (≤60 years old) and 1.05 (0.93 to 1.19) and 1.08 (0.95 to 1.23), respectively, for older patients.Conclusions Mediterranean and DASH diets did not associate with cardiovascular or total mortality in hemodialysis.

Keywords: DASH diet; Dietary patterns; Mediterranean diet; end-stage kidney disease; hemodialysis; mortality.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Study flow chart showing the process resulting in the inclusion of 8110 participants in analyses and all censoring details.
Figure 2.
Figure 2.
(A) Mediterranean and (B) Dietary Approaches to Stop Hypertension (DASH) diet score distributions in patients who died from cardiovascular or any cause were similar to those in patients who survived to the end of follow-up. Percentage of cardiovascular (left plots) and all-cause mortality (right plots) were plotted against Mediterranean (top plots) and DASH (bottom plots) diet scores in patients who died and in patients who survived to the end of follow-up.
Figure 3.
Figure 3.
Kaplan–Meier estimates of all-cause mortality by tertiles of Dietary Approaches to Stop Hypertension scores stratified by age groups showing an association between higher DASH diet scores and lower risk of all-cause mortality in younger (aged ≤ 60 years), but not in older patients. Log-rank test compares the risk of all-cause mortality across tertiles of DASH diet score in patients aged 60 years or younger (curves on the left) and in older patients (curves on the right).
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