DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease

Abstract

Background There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention. Evidence is lacking for effective dietary patterns for kidney disease prevention. Study Design Prospective cohort study Setting & Participants Atherosclerosis Risk in Communities (ARIC) study participants with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 (N=14,882) Predictor The Dietary Approaches to Stop Hypertension (DASH) diet score was calculated based on self-reported dietary intake of red and processed meat, sweetened beverages, sodium, fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy products, averaged over two visits. Outcomes Cases were ascertained based on development of eGFR <60 mL/min/1.73 m2 accompanied by ≥25% eGFR decline from baseline, an ICD-9/10 code for a kidney disease–related hospitalization or death, or end-stage renal disease from baseline through 2012. Results A total of 3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile (HR, 1.16; 95% CI, 1.07-1.26; p for trend <0.001), after adjusting for socio-demographics, smoking status, physical activity, total caloric intake, baseline eGFR, overweight/obese status, diabetes status, hypertension status, systolic blood pressure, and anti-hypertensive medication use. Of the individual components of the DASH diet score, high intake of red and processed meat was adversely associated with kidney disease and high intake of nuts, legumes, and low-fat dairy products was associated with reduced risk of kidney disease. Limitations Potential measurement error due to self-reported dietary intake and lack of data on albuminuria Conclusions Consuming a DASH-style diet was associated with lower risk for kidney disease, independent of demographic characteristics, established kidney risk factors, and baseline kidney function. Healthful dietary patterns, such as the DASH diet, may be beneficial for kidney disease prevention.

Associations between dairy food consumption and chronic kidney disease in older adults

“…Our finding that consumption of low/reduced fat dairy foods was inversely associated with the prevalence and incidence of CKD concurs with recent findings from the ARIC study, which also showed a protective effect of low-fat dairy products on CKD13. Further, previous studies have shown a protective effect of habitual dairy product consumption on various health outcomes including diabetes, hypertension and cardiovascular disease1234 and this supports the protective effect of dairy foods observed in this cohort.…”

“…However, there are a lack of studies that have examined the link between dairy intake and CKD risk. One of the few studies to have recently examined this association was the Atherosclerosis Risk in Communities (ARIC) Study, which specifically analysed the link between the Dietary Approaches to Stop Hypertension (DASH) diet score and risk of CKD13. This study showed that of the individual components of the DASH diet score, low-fat dairy product intake was associated with reduced risk for kidney disease.…”

Beyond Sodium, Phosphate and Potassium: Potential Dietary Interventions in Kidney Disease

“…Preliminary data also suggest that adherence to the DASH diet may reduce the risk of ESKD incidence in people with established CKD (56), and a small single arm trial demonstrated the DASH diet as safe in a CKD sample (57). Other studies demonstrate that the DASH dietary pattern is associated with preserved residual kidney function and reduced overall incidence of CKD in community-dwelling individuals (54,58,59).…”

“…There is a paucity of evidence for the effectiveness of changing dietary patterns in the established CKD population. However, emerging data support the belief that dietary patterns that follow the Healthy Eating Index, DASH, and the Mediterranean diet are associated with reduced renal-related mortality and slower progression to ESKD (47,54,55). Preliminary data also suggest that adherence to the DASH diet may reduce the risk of ESKD incidence in people with established CKD (56), and a small single arm trial demonstrated the DASH diet as safe in a CKD sample (57).…”

Nephro Update Europe 2017

“…In the ARIC study published in the American Journal of Kidney Disease in 2016 [4] , the results were that with an increased use of a DASH-like diet (consisting of fruits and vegetables, less red meat, less sodium, and increased potassium) the risk of incident CKD decreased. These observational data are not surprising, but at the very least, they are reassuring.…”