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Dietary risk factors for incidence or progression of chronic kidney disease in individuals with type 2 diabetes in the European Union.
Nephrol Dial Transplant. 2015 Aug; 30 Suppl 4:iv76-85.ND

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Dunkler D
Section for Clinical Biometrics, Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Vienna, Austria.
Kohl M
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.
Teo KK
Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
Heinze G
Section for Clinical Biometrics, Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Vienna, Austria.
Dehghan M
Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
Clase CM
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Gao P
Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
Yusuf S
Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
Mann JF
Department of Nephrology, University of Erlangen-Nürnberg, Erlangen, Germany Schwabing General Hospital, and KfH Kidney Center, Munich, Germany.
Oberbauer R
Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.

MeSH

AgedDiabetes Mellitus, Type 2DietDisease ProgressionEuropean UnionFeeding BehaviorFemaleGlomerular Filtration RateHumansIncidenceMaleMiddle AgedRenal Insufficiency, ChronicRisk Factors

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26209742

Clinical Trial Links

Clinical trial which this article describes
Effect of the Teleconsultation of Renal Nutrition on Renal Function and Glycemic Control in Patients With DKD

Citation

Dunkler, Daniela, et al. "Dietary Risk Factors for Incidence or Progression of Chronic Kidney Disease in Individuals With Type 2 Diabetes in the European Union." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 30 Suppl 4, 2015, pp. iv76-85.
Dunkler D, Kohl M, Teo KK, et al. Dietary risk factors for incidence or progression of chronic kidney disease in individuals with type 2 diabetes in the European Union. Nephrol Dial Transplant. 2015;30 Suppl 4:iv76-85.
Dunkler, D., Kohl, M., Teo, K. K., Heinze, G., Dehghan, M., Clase, C. M., Gao, P., Yusuf, S., Mann, J. F., & Oberbauer, R. (2015). Dietary risk factors for incidence or progression of chronic kidney disease in individuals with type 2 diabetes in the European Union. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 30 Suppl 4, iv76-85. https://doi.org/10.1093/ndt/gfv086
Dunkler D, et al. Dietary Risk Factors for Incidence or Progression of Chronic Kidney Disease in Individuals With Type 2 Diabetes in the European Union. Nephrol Dial Transplant. 2015;30 Suppl 4:iv76-85. PubMed PMID: 26209742.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary risk factors for incidence or progression of chronic kidney disease in individuals with type 2 diabetes in the European Union. AU - Dunkler,Daniela, AU - Kohl,Maria, AU - Teo,Koon K, AU - Heinze,Georg, AU - Dehghan,Mahshid, AU - Clase,Catherine M, AU - Gao,Peggy, AU - Yusuf,Salim, AU - Mann,Johannes F E, AU - Oberbauer,Rainer, PY - 2015/7/26/entrez PY - 2015/7/26/pubmed PY - 2016/3/25/medline KW - chronic kidney disease KW - diet KW - lifestyle KW - mortality SP - iv76 EP - 85 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 30 Suppl 4 N2 - 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. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/26209742/Dietary_risk_factors_for_incidence_or_progression_of_chronic_kidney_disease_in_individuals_with_type_2_diabetes_in_the_European_Union_ DB - PRIME DP - Unbound Medicine ER -