Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Abstract

Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177‐item food frequency questionnaire and an overall DASH‐score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow‐up of 5.3 (interquartile range, 4.1‐6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death‐censored graft failure, and 128 (20.3%) died. In Cox‐regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33‐0.96, P = .03) and all‐cause mortality (HR = 0.52; 95%CI, 0.32‐0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH‐style diet is associated with lower risk of both renal function decline and all‐cause mortality. These results suggest that a healthful diet might benefit long‐term outcome in RTR.

Inherited salt-losing tubulopathies are associated with immunodeficiency due to impaired IL-17 responses

“…Disease controls are patients attending tubular disorders clinics with a diagnosis that is not associated with renal salt wasting (Supplemental Table 2). The median age of SLT patients is 35 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) years and 26 (55.3%) patients are female. Biochemical findings at the time of recruitment are typical of SLT, with hypokalaemic metabolic alkalosis and frequent hypomagnesaemia (Supplemental Table 3).…”

“…Studies to date on the effect of altered sodium balance on immunity have largely focused on salt loading and how this impacts inflammatory or autoimmune disease. Alongside the inflammatory effect of sodium demonstrated on multiple immune cells in vitro and in animal models, increased sodium intake in patients has been linked to the development of rheumatoid arthritis, correlates with disease severity in multiple sclerosis, and worsens renal allograft outcomes independently of any blood pressure effect [35][36][37] . These data imply that reducing salt intake also impacts immunity and may ameliorate diverse inflammatory states, but this hypothesis is untested and the immunological consequences of chronic salt depletion are unknown.…”

Nutrition Trends in Kidney Transplant Recipients: the Importance of Dietary Monitoring and Need for Evidence-Based Recommendations

“…In a dietary analysis of 632 Dutch KTR, the Dietary Approach to Stop Hypertension (DASH) score was calculated through food frequency questionnaires administered over 5 years ( 64 ). The highest tertile of DASH scores had more than a 50% reduction in both renal function decline (HR = 0.57; 95% CI, 0.33–0.96, P = 0.03) and all-cause mortality (HR = 0.52; 95% CI, 0.32–0.83, P = 0.006) when compared to the lowest group after controlling for age, kidney function, transplant characteristics, and sex.…”

Physical Activity and the Development of Post-Transplant Diabetes Mellitus, and Cardiovascular- and All-Cause Mortality in Renal Transplant Recipients

“…This effect may also be due to improvements in metabolic dysfunctions, such as insulin resistance, impaired glucose tolerance, dyslipidemia, and hypertension, all of which are related to (central) adiposity [45][46][47]. Furthermore, a number of studies on diet analysed in-depth the effect of dietary factors on the same outcomes such as PTDM, renal function decline and mortality [23][24][25]33,48]. They suggest that lifestyle is very important for RTR, however, it should be noted that MVPA in daily life has not gotten that much attention.…”