title: Dietary risk factors for incidence or progression of chronic kidney disease in individuals with type 2 diabetes in the European Union.
abstract: BACKGROUND
  Although the prevalence of chronic kidney disease (CKD) is ∼ 30% in the group of people with diabetes, data on interventions in the very early stage of the disease are still missing. Furthermore, the effects of modifiable lifestyle factors such as nutrition on incidence and progression of CKD in patients with diabetes in Europe remain elusive.
  
  
  METHODS
  We analyzed whether diet quality and adherence to dietary guidelines using the modified Alternate Healthy Eating Index (mAHEI) score was associated with CKD incidence or progression after 5.5 years in 3088 European participants of the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) with type 2 diabetes and baseline normo- or micro-albuminuria. Death was considered as a competing risk in the multinomial logit regression models, which were adjusted for age, gender, duration of diabetes, ONTARGET randomization, baseline albuminuria and glomerular filtration rate (GFR). We also estimated the potential impact on population health of improvement in diet quality.
  
  
  RESULTS
  At study end, 450 (14.6%) participants had died and 926 (30%) had experienced the renal endpoint of incidence or progression of CKD, of which 422 (13.7%) participants had progressed to micro- or macro-albuminuria, 596 (19.3%) had a GFR-decline of >5% per year and 18 (0.6%) had developed end-stage renal disease. Participants in the healthiest tertile of the mAHEI score had a decreased risk of incidence or progression of CKD (odds ratio 0.8, 95% confidence interval 0.68-0.94) and death (0.65, 0.52-0.81) compared with participants in the least healthy tertile. If individuals with a suboptimal dietary quality (e.g. mAHEI < 28) were able to improve their diet to an mAHEI of 28, 3.2% of CKD incidence or progression and 10.0% of deaths might be avoided in 5.5 years.
  
  
  CONCLUSIONS
  If the association between diet and these endpoints is causal, then optimizing diet quality in individuals with diabetes who have no CKD or very early CKD would have substantial population benefits in terms of prevention of CKD incidence or progression and mortality in this high-risk population.
authors.affiliation: Section for Clinical Biometrics, Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Vienna, Austria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.affiliation: Section for Clinical Biometrics, Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Vienna, Austria Department of Nephrology, University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Kohl
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.affiliation: Section for Clinical Biometrics, Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Mahshid
authors.initials: M
authors.lastname: Dehghan
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Clase
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Peggy
authors.initials: P
authors.lastname: Gao
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.affiliation: Department of Nephrology, University of Erlangen-Nürnberg, Erlangen, Germany Schwabing General Hospital, and KfH Kidney Center, Munich, Germany.
authors.forename: Johannes F E
authors.initials: JF
authors.lastname: Mann
authors.affiliation: Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D004032:Diet; D018450:Disease Progression; D005062:European Union; D005247:Feeding Behavior; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors
keywords: chronic kidney disease; diet; lifestyle; mortality