title: Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study.
abstract: BACKGROUND
  Nutrition is linked strongly with health outcomes in chronic kidney disease (CKD). However, few studies have examined relationships between dietary patterns and health outcomes in persons with CKD.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  3,972 participants with CKD (defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-creatinine ratio ≥ 30 mg/g at baseline) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a prospective cohort study of 30,239 black and white adults at least 45 years of age.
  
  
  METHODS
  5 empirically derived dietary patterns identified by factor analysis: "convenience" (Chinese and Mexican foods, pizza, and other mixed dishes), "plant-based" (fruits and vegetables), "sweets/fats" (sugary foods), "Southern" (fried foods, organ meats, and sweetened beverages), and "alcohol/salads" (alcohol, green-leafy vegetables, and salad dressing).
  
  
  RESULTS
  All-cause mortality and end-stage renal disease (ESRD).
  
  
  RESULTS
  816 deaths and 141 ESRD events were observed over approximately 6 years of follow-up. There were no statistically significant associations of convenience, sweets/fats, or alcohol/salads pattern scores with all-cause mortality after multivariable adjustment. In Cox regression models adjusted for sociodemographic factors, energy intake, comorbid conditions, and baseline kidney function, higher plant-based pattern scores (indicating greater consistency with the pattern) were associated with lower risk of mortality (HR comparing fourth to first quartile, 0.77; 95% CI, 0.61-0.97), whereas higher Southern pattern scores were associated with greater risk of mortality (HR comparing fourth to first quartile, 1.51; 95% CI, 1.19-1.92). There were no associations of dietary patterns with incident ESRD in multivariable-adjusted models.
  
  
  CONCLUSIONS
  Missing dietary pattern data, potential residual confounding from lifestyle factors.
  
  
  CONCLUSIONS
  A Southern dietary pattern rich in processed and fried foods was associated independently with mortality in persons with CKD. In contrast, a diet rich in fruits and vegetables appeared to be protective.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: ogutierr@uab.edu.
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Dana V
authors.initials: DV
authors.lastname: Rizk
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, GA; Department of Medicine, Emory University, Atlanta, GA.
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA; Program in Graduate Medical Nutrition Sciences, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA; Program in Gastronomy, Culinary Arts, and Wine Studies, Boston University Metropolitan College, Boston, MA.
authors.forename: P K
authors.initials: PK
authors.lastname: Newby
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000178:diet therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000178:diet therapy / Q000401:mortality; D012307:Risk Factors
keywords: Dietary pattern; chronic kidney disease (CKD); disease progression; kidney failure; modifiable risk factor; mortality risk; nutrition