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. 2022 Sep 7;3(11):1852-1860.
doi: 10.34067/KID.0000442022. eCollection 2022 Nov 24.

Proinflammatory Diets and Risk of ESKD in US Adults with CKD

Tanushree Banerjee  1 , Charles E McCulloch  2 , Deidra C Crews  3   4 , Nilka Rios Burrows  5 , Meda E Pavkov  5 , Rajiv Saran  6 , Hal Morgenstern  7 , Jennifer Bragg-Gresham  6 , Neil R Powe  8 ; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team; CDC CKD Surveillance Team
Collaborators, Affiliations

Proinflammatory Diets and Risk of ESKD in US Adults with CKD

Tanushree Banerjee et al. Kidney360. .

Abstract

Background: Inflammation may affect long-term kidney function. Diet may play a role in chronic inflammation. We hypothesized that proinflammatory diets increase the risk of progression to kidney failure with replacement therapy (KFRT), and systemic inflammation is a mediator of the effect of diet on progression to KFRT.

Methods: In the 1988-1994 National Health and Nutrition Examination Survey linked to the national ESKD registry, in adults with CKD (eGFR 15-59 ml/min per 1.73 m2), aged ≥20 years, we calculated the Adapted Dietary Inflammatory Index (ADII) at baseline from a 24-hour dietary recall and an inflammation score (IS) using average of z scores of four inflammation biomarkers. We explored the association of the ADII and IS with risk of incident KFRT using Cox proportional model, adjusting for sociodemographics, physical activity, Framingham risk score, eGFR, and urinary ACR. We evaluated whether, and to what extent, IS mediated the effect of the ADII on KFRT incidence, using causal mediation analysis.

Results: Of 1084 adults with CKD, 109 (10%) developed KFRT. The ADII was associated with increased risk of KFRT (relative hazard [RH] per SD increase (2.56): 1.4 [1.04-1.78]). IS was also associated with KFRT (RH: 1.12; 95% CI, 1.02 to 1.25). Approximately 36% of the association between the ADII and KFRT was explained by IS.

Conclusions: Among adults with CKD, a proinflammatory diet was associated with risk of KFRT, and that association was partially explained by an increase in inflammatory markers. Dietary interventions that reduce inflammation may offer an approach for preventing KFRT.

Keywords: ADII; chronic kidney disease; diet; end stage kidney disease; epidemiology and outcomes; inflammation.

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Conflict of interest statement

D.C. Crews reports consultancy for Yale New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE); research funding from Baxter International and Somatus, Inc.; honoraria from Maze Therapeutics; an advisory or leadership role on the editorial board for the Clinical Journal of the American Society of Nephrology, Journal of Renal Nutrition, and Journal of the American Society of Nephrology; as an associate editor of Kidney360; a co-chair of Bayer HealthCare Pharmaceuticals, Inc., Patient and Physician Advisory Board Steering Committee for Disparities in Chronic Kidney Disease Project; on the advisory group for Health Equity Collaborative, Partner Research for Equitable System Transformation after COVID-19 (PRESTAC), Optum Labs; and other interests or relationships with the American Board of Internal Medicine (nephrology board), the American College of Physicians (council of subspecialist societies), and the National Kidney Foundation of Maryland/Delaware (board of directors). M.E. Pavkov reports an advisory or leadership role for Kidney Health Initiative (board of directors). N.R. Powe reports an advisory or leadership role for the Patient Centered Outcomes Research Institute, Robert Wood Johnson Foundation, University of Washington, Vanderbilt University, and Yale University. R. Saran reports consultancy for KHK, Japan; honoraria from Baylor Scott and White Health System, Fresenius Medical Care’s Renal Research Institute, the Japanese Society of Dialysis and Transplantation, Nutek Food Sciences, and Reata Pharmaceuticals; an advisory or leadership role for the National Kidney Foundation of Michigan (scientific advisory board) and Reata Pharmaceuticals; and other interests or relationships with the American Nephrologists of Indian Origin (steering committee member) and the World Federation of Non Communicable Diseases (international advisory council member). All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Hazard ratio for the association between one-SD (2.56) increase in the Adapted Dietary Inflammatory Index (ADII) and the incidence rate of ESKD among 1084 adults with CKD.
See this image and copyright information in PMC

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