title: The Associations of Plant Protein Intake With All-Cause Mortality in CKD.
abstract: BACKGROUND
  Plant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  14,866 NHANES III participants 20 years or older without missing data for plant and animal protein intake and mortality.
  
  
  METHODS
  Plant protein to total protein ratio and total plant protein intake. Patients were stratified by estimated glomerular filtration rate (eGFR)<60 or ≥60mL/min/1.73m(2).
  
  
  RESULTS
  All-cause mortality.
  
  
  METHODS
  Plant and total protein intakes were estimated from 24-hour dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through December 31, 2000.
  
  
  RESULTS
  Mean values for plant protein intake and plant protein to total protein ratio were 24.6±13.2 (SD) g/d and 33.0% ± 14.0%, respectively. The prevalence of eGFRs<60mL/min/1.73m(2) was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbid conditions, body mass index, calorie and total protein intake, and physical inactivity, each 33% increase in plant protein to total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR≥60mL/min/1.73m(2) subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR<60mL/min/1.73m(2) subpopulation. In sensitivity analyses, results were similar in those with eGFR<60mL/min/1.73m(2) defined by serum cystatin C level.
  
  
  CONCLUSIONS
  Whether results are related to plant protein itself or to other factors associated with more plant-based diets is difficult to establish.
  
  
  CONCLUSIONS
  A diet with a higher proportion of protein from plant sources is associated with lower mortality in those with eGFR<60mL/min/1.73m(2). Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR<60mL/min/1.73m(2).
authors.affiliation: Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; Division of Nutrition, University of Utah, Salt Lake City, UT.
authors.forename: Xiaorui
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Guo
authors.initials: G
authors.lastname: Wei
authors.affiliation: Division of Nutrition, University of Utah, Salt Lake City, UT.
authors.forename: Thunder
authors.initials: T
authors.lastname: Jalili
authors.affiliation: Division of Nutrition, University of Utah, Salt Lake City, UT.
authors.forename: Julie
authors.initials: J
authors.lastname: Metos
authors.affiliation: Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Ajay
authors.initials: A
authors.lastname: Giri
authors.affiliation: Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; VA Healthcare System, Salt Lake City, UT.
authors.forename: Monique E
authors.initials: ME
authors.lastname: Cho
authors.affiliation: Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Robert
authors.initials: R
authors.lastname: Boucher
authors.affiliation: VA Healthcare System, Salt Lake City, UT.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.affiliation: Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; VA Healthcare System, Salt Lake City, UT. Electronic address: Srinivasan.beddhu@hsc.utah.edu.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
mesh_terms: D000328:Adult; D015992:Body Mass Index; D055316:Cystatin C / Q000097:blood; D004044:Dietary Proteins / Q000378:metabolism*; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009749:Nutrition Surveys; D010940:Plant Proteins / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D055316:Cystatin C; D004044:Dietary Proteins; D010940:Plant Proteins
keywords: NHANES (National Health and Nutrition Examination Survey); Plant protein; animal protein; chronic kidney disease (CKD); decreased renal function; diet; dietary recall; disease progression; estimated glomerular filtration rate (eGFR); mortality; nutrition; protein intake