Kidney Week

Abstract: FR-PO1067

Associations of Kidney Dietary Adherence with Kidney Function among Veterans with Diabetic Kidney Disease

Session Information

• Kidney Nutrition and Metabolism
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Perez, Luis M., Veterans Affairs, Aurora, Colorado, United States

Luis M. Perez, PhD, RD

• Wilson, Otis D., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Otis D. Wilson

• Triozzi, Jefferson Lorenzo, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Jefferson Lorenzo Triozzi, MD

• Jones, Christine D., Veterans Affairs, Aurora, Colorado, United States

Christine D. Jones, MD

• Hung, Adriana, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Adriana Hung, MD, MPH

• Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Talat Alp Ikizler, MD, FASN

• Sun, Yan, Emory University, Atlanta, Georgia, United States

Yan Sun, PhD

• Raghavan, Sridharan, Veterans Affairs, Aurora, Colorado, United States

Sridharan Raghavan, MD, PhD

Group or Team Name

• Million Veteran Program.

Background

Dietary management of chronic kidney disease (CKD) is a key component of improving clinical outcomes, quality of life, and potentially delaying or preventing the progression of kidney disease. Despite debate regarding CKD dietary guidelines, Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations for dietary management and CKD medically tailored meal (MTM) standards provide a foundational basis for nutritional interventions. The aim of this study was to evaluate the relationship between dietary patterns and diabetic CKD progression among Veterans in the VA Million Veteran Program (MVP).

Methods

We studied 11,477 Veteran MVP participants with diabetic CKD with nutrition and health data available. We developed a CKD diet score reflecting patient adherence to eight nutrient recommendations (0-2 points each; total of 16 points) based on KDOQI and MTM standards. We calculated potential renal acid load (PRAL in mEq/d) as a second dietary predictor variable. We used generalized linear models to estimate the association of the CKD diet score with co-primary study outcomes, estimated glomerular filtration (eGFR) at 0- and 12-months and 12-month progression to end-stage kidney disease (ESKD; eGFR <15 mL/min/1.73m²). Models were incrementally adjusted for age, body mass index (BMI), race/ethnicity, smoking, medications, baseline eGFR, hemoglobin a1c, blood pressure, and cardiovascular disease.

Results

Participant demographics were mean (± standard deviation) age 71 ± 9 years, BMI 32.5 ± 6.5 kg/m², 97.2% male, and baseline eGFR 40.4 ± 18.1 mL/min/1.73m². Higher CKD diet scores, β 0.360 (95% confidence interval 0.091 to 0.629, p=0.01), and lower PRAL values, β -0.077 (-0.098 to -0.056, p<0.01), were associated with higher baseline (0-month) kidney function in fully adjusted models. However, CKD diet scores and PRAL were not associated with 12-month eGFR change or ESKD progression (both p>0.05) in any models.

Conclusion

In adults with diabetic CKD, kidney dietary adherence and lower PRAL were associated with higher kidney function at baseline, but not eGFR change or reduced ESKD progression over a one-year period. Further research is needed to understand and isolate the mid- to long-term impacts of diet for kidney disease progression.

Funding

• Veterans Affairs Support