A worsening diet may lead to an earlier death in adults with chronic kidney disease, according to new research published in the American Journal of Kidney Diseases.
Chronic kidney disease can develop due to elevated blood glucose levels over time, which damage the tiny blood vessels in the kidneys that filter waste and excess fluid from the body. When the kidneys can no longer effectively filter waste products from the blood — known as kidney failure — dialysis (mechanical filtration of the blood) or a kidney transplant is needed to stay alive. Among people with diabetes, new cases of kidney disease are higher in certain racial and ethnic minority groups, highlighting the role that social factors play in this area of health. Obesity is also linked to a higher risk for diabetic kidney disease, and bariatric (weight-loss) surgery has been shown to be more beneficial for kidney disease outcomes than standard treatments. Several drugs are known to slow the progression of chronic kidney disease, and some of these drugs may have additional benefits like a lower risk for pneumonia. Dietary factors have also been shown to play a role in kidney disease development and progression. Eating ultra-processed foods is linked to a higher risk for chronic kidney disease, and one study showed that people with chronic kidney disease tend to eat fewer fruits and vegetables.
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For the latest study, researchers looked at changes in dietary patterns over four years in 1,396 adults with chronic kidney disease. Used on a dietary rating system called the Alternative Healthy Eating Index, they grouped all participants into one of four categories: having a sustained low score (510 participants), having an improved score from low to high (197 participants), having a sustained high score (527 participants), and having a worsened score from high to low (162 participants). The average age of participants in each group ranged from 61 to almost 65, and women were more likely to have a sustained high score, while men were more likely to have a sustained low score. A high or low score was defined as being above or below the median score of all participants.
The researchers then calculated the relationship between changes in dietary scores and two different outcomes in the following years — kidney disease progression as defined by at least a 50% reduction in eGFR (estimated glomerular filtration rate, a measure of kidney function) or starting on dialysis, and death from all causes. Overall, 412 participants experienced kidney disease progression as defined by the researchers during a median follow-up period of 7.0 years, and 393 participants died during a median follow-up period of 9.4 years.
Worsening diet linked to higher risk of kidney disease progression
Among participants with diabetes, those with a worsened dietary score were 93% more likely to experience kidney disease progression than those with a sustained high score, and 63% more likely to experience kidney disease progression than those with a sustained high or low score. Among participants with or without diabetes, a worsened dietary score was linked to a 41% higher risk of dying compared with a sustained high score, and a sustained low score was also linked to a 41% higher risk of dying compared with a sustained high score. Compared with a stable high or low score, a worsened score was linked to a 34% higher risk of dying.
The researchers concluded that worsening dietary quality may predict earlier death in adults with chronic kidney disease, and kidney disease progression in those with both diabetes and chronic kidney disease. Further research is needed to find out whether dietary interventions could help reduce these heightened risks for kidney disease progression or death.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “How to Keep Your Kidneys Healthy,” “Protecting Your Kidneys,” and “Kidney Disease: Your Seven-Step Plan for Prevention.”
