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Original Investigation Pathogenesis and Treatment of Kidney Disease| Volume 68, ISSUE 6, P853-861, December 01, 2016

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

  • Casey M. Rebholz
    Correspondence
    Address correspondence to Casey M. Rebholz, PhD, MS, MPH, Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 E Monument St, Ste 2-600, Baltimore, MD 21287.
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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  • Deidra C. Crews
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD

    Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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  • Morgan E. Grams
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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  • Lyn M. Steffen
    Affiliations
    Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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  • Andrew S. Levey
    Affiliations
    William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
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  • Edgar R. Miller III
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD

    Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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  • Lawrence J. Appel
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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  • Josef Coresh
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Published:August 09, 2016DOI:https://doi.org/10.1053/j.ajkd.2016.05.019

      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 2 visits.

      Outcomes

      Cases were ascertained based on the development of eGFRs < 60 mL/min/1.73 m2 accompanied by ≥25% eGFR decline from baseline, an International Classification of Diseases, Ninth/Tenth Revision code for a kidney disease−related hospitalization or death, or end-stage renal disease from baseline through 2012.

      Results

      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 sociodemographics, smoking status, physical activity, total caloric intake, baseline eGFR, overweight/obese status, diabetes status, hypertension status, systolic blood pressure, and antihypertensive medication use. Of the individual components of the DASH diet score, high red and processed meat intake was adversely associated with kidney disease and high nuts, legumes, and low-fat dairy products intake was associated with reduced risk for kidney disease.

      Limitations

      Potential measurement error due to self-reported dietary intake and lack of data for 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.

      Index Words

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