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 CKD. Study Design Observational study Settings & Participants 14,866 NHANES III participants aged 20 years or older without missing data for plant and animal protein intake and mortality. Predictors Plant protein–total protein ratio and total plant protein intake. Patients were stratified by eGFR < or ≥ 60 ml/min/1.73 m2. Outcomes All-cause mortality. Measurements Plant and total protein intakes were estimated from 24h dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through 12/31/2000. Results The mean of plant protein intake and plant protein–total protein ratio were 24.6 ± 13.2 (SD) g/d and 33.0% ± 14.0%, respectively. The prevalence of eGFR < 60 ml/min/1.73 m2 was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbidity, BMI, calorie and total protein intake and physical inactivity, each 33% increase in plant protein–total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR ≥60 mL/min/1.73 m2 subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR < 60 mL/min/1.73 m2 subpopulation. In sensitivity analyses, results were similar in those with eGFR < 60 mL/min/1.73 m2 defined by serum cystatin C. Limitations Whether the results are related to plant protein itself or to other factors associated with more plant-based diets is hard to establish. Conclusions A diet with higher proportion of protein from plant sources is associated with lower mortality in those with eGFR < 60 mL/min/1.73 m2. Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR < 60 mL/min/1.73 m2.

BackgroundIntensive systolic blood pressure (SBP) lowering significantly reduced cardiovascular disease (CVD) events in SPRINT (Systolic Blood Pressure Intervention Trial) but not in ACCORD BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure).Methods and Results SPRINT tested the effects of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP goals on CVD events and all‐cause mortality. Using 2×2 factorial design, ACCORD BP tested the same SBP intervention in addition to an intensive versus standard glycemia intervention. We compared the effects of intensive SBP lowering on the composite CVD end point and all‐cause mortality in SPRINT with its effects within each of the glycemia arms in ACCORD BP. Intensive SBP lowering decreased the hazard of the composite CVD end point similarly in SPRINT (hazard ratio: 0.75; 95% confidence interval, 0.64–0.89) and in the ACCORD BP standard glycemia arm (hazard ratio: 0.77; 95% confidence interval, 0.63–0.95; interaction P=0.87). However, the effect of intensive SBP lowering on the composite CVD end point in the ACCORD BP intensive glycemia arm (hazard ratio: 1.04; 95% confidence interval, 0.83–1.29) was significantly different from SPRINT (interaction P=0.023). Patterns were similar for all‐cause mortality.ConclusionsThe effects of intensive SBP control on CVD events and all‐cause mortality were similar in patients without diabetes mellitus and in those with diabetes mellitus on standard glycemic control. An interaction between intensive SBP lowering and intensive glycemic control may have masked beneficial effects of intensive SBP lowering in ACCORD BP.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01206062, NCT00000620.

National Institutes of Health.

Objective We investigate whether psoas or paraspinous muscle area measured on a single L4–5 image is a useful measure of whole lean body mass compared to dedicated mid-thigh magnetic resonance imaging (MRI). Design Observational study. Setting Outpatient dialysis units and a research clinic. Subjects 105 adult participants on maintenance hemodialysis. No control group was used. Exposure variables Psoas muscle area, paraspinous muscle area, and mid-thigh muscle area (MTMA) were measured by MRI. Main outcome measure Lean body mass was measured by dual-energy absorptiometry (DEXA) scan. Results In separate multivariable linear regression models, psoas, paraspinous, and mid-thigh muscle area were associated with increase in lean body mass. In separate multivariate logistic regression models, c-statistics for diagnosis of sarcopenia (defined as < 25th percentile of lean body mass) were 0.69 for paraspinous muscle area, 0.81 for psoas muscle area, and 0.89 for mid-thigh muscle area. With sarcopenia defined as < 10th percentile of lean body mass, the corresponding c-statistics were 0.71, 0.92, and 0.94. Conclusions We conclude that psoas muscle area provides a good measure of whole body muscle mass, better than paraspinous muscle area but slightly inferior to mid thigh measurement. Hence, in body composition studies a single axial MR image at the L4–L5 level can be used to provide information on both fat and muscle and may eliminate the need for time-consuming measurement of muscle area in the thigh.

ACR values are decreasing in U.S. adults with diabetes, but optimal management strategies are needed to reduce mortality in those with a low eGFR and an ACR <30 mg/g.