title: Association between water intake, chronic kidney disease, and cardiovascular disease: a cross-sectional analysis of NHANES data.
abstract: BACKGROUND
  Evidence from animal and human studies suggests a protective effect of higher water intake on kidney function and cardiovascular disease (CVD). Here the associations between water intake, chronic kidney disease (CKD) and CVD were examined in the general population.
  
  
  METHODS
  We conducted a cross-sectional analysis of the 2005-2006 National Health and Nutrition Examination Survey. Non-pregnant adults with an estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73 m(2) who were not taking diuretics were included. Total water intake from foods and beverages was categorized as low (<2.0 l/day), moderate (2.0-4.3 l/day) and high (>4.3 l/day). We examined associations between low total water intake and CKD (eGFR 30-60 ml/min/1.73 m(2)) and self-reported CVD.
  
  
  RESULTS
  Of 3,427 adults (mean age 46 (range 20-84); mean eGFR 95 ml/min/1.73 m(2) (range 30-161)), 13% had CKD and 18% had CVD. CKD was higher among those with the lowest (<2.0 l/day) vs. highest total water intake (>4.3 l/day) (adjusted odds ratio (OR) 2.52; 95% confidence interval (CI) 0.91-6.96). When stratified by intake of (1) plain water and (2) other beverages, CKD was associated with low intake of plain water: adjusted OR 2.36 (95% CI 1.10-5.06), but not other beverages: adjusted OR 0.87 (95% CI 0.30-2.50). There was no association between low water intake and CVD (adjusted OR 0.76; 95% CI 0.37-1.59).
  
  
  CONCLUSIONS
  Our results provide additional evidence suggesting a potentially protective effect of higher total water intake, particularly plain water, on the kidney.
authors.affiliation: Department of Medicine, Kidney Clinical Research Unit, Division of Nephrology, London Health Sciences Centre, London, Ont., Canada.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Sontrop
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Dixon
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Buendia-Jimenez
authors.forename: Oriane
authors.initials: O
authors.lastname: Dohein
authors.forename: Shih-Han S
authors.initials: SH
authors.lastname: Huang
authors.forename: William F
authors.initials: WF
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004326:Drinking; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult