title: Relative energy balance, CKD, and risk of cardiovascular and all-cause mortality.
abstract: BACKGROUND
  Mortality risk for people with chronic kidney disease is substantially greater than that for the general population, increasing to a 7-fold greater risk for those on dialysis therapy. Higher body mass index, generally due to higher energy intake, appears protective for people on dialysis therapy, but the relationship between energy intake and survival in those with reduced kidney function is unknown.
  
  
  METHODS
  Prospective cohort study with a median follow-up of 14.5 (IQR, 11.2-15.2) years.
  
  
  METHODS
  Blue Mountains Area, west of Sydney, Australia. Participants in the general community enrolled in the Blue Mountains Eye Study (n = 2,664) who underwent a detailed interview, food frequency questionnaire, and physical examination including body weight, height, blood pressure, and laboratory tests.
  
  
  METHODS
  Relative energy intake, food components (carbohydrates, total sugars, fat, protein, and water), and estimated glomerular filtration rate (eGFR). Relative energy intake was dichotomized at 100%, and eGFR, at 60 mL/min/1.73 m(2).
  
  
  RESULTS
  All-cause and cardiovascular mortality.
  
  
  METHODS
  All-cause and cardiovascular mortality using unadjusted and adjusted Cox proportional regression models.
  
  
  RESULTS
  949 people died during follow-up, 318 of cardiovascular events. In people with eGFR<60 mL/min/1.73 m(2) (n = 852), there was an increased risk of all-cause mortality (HR, 1.48; P = 0.03), but no increased risk of cardiovascular mortality (HR, 1.59; P = 0.1) among those with higher relative energy intake compared with those with lower relative energy intake. Increasing intake of carbohydrates (HR per 100g/d, 1.50; P = 0.04) and total sugars (HR per 100g/d, 1.62; P = 0.03) was associated significantly with increased risk of cardiovascular mortality.
  
  
  CONCLUSIONS
  Under-reporting of energy intake, baseline laboratory and food intake values only, white population.
  
  
  CONCLUSIONS
  Increasing relative energy intake was associated with increased all-cause mortality in patients with eGFR<60 mL/min/1.73 m(2). This effect may be mediated by increasing total sugars intake on subsequent cardiovascular events.
authors.affiliation: Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead, Sydney, Australia; Institute for Social and Preventive Medicine, University Bern, Bern, Switzerland. Electronic address: siff@ispm.unibe.ch.
authors.forename: Samuel
authors.initials: S
authors.lastname: Iff
authors.affiliation: Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Webster
authors.affiliation: School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Flood
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D002423:Cause of Death / Q000639:trends; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Chronic kidney disease; all-cause mortality; cardiovascular mortality; energy intake; relative energy balance