Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study

Rationale & Objective Ultraprocessed foods are widely consumed in the US and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the general population. We investigated associations between ultraprocessed food intake and chronic kidney disease (CKD) progression, all-cause mortality, and incident CVD in adults with CKD. Study Design Prospective cohort study. Setting & Participants Chronic Renal Insufficiency Cohort (CRIC) Study participants who completed baseline dietary questionnaires. Exposure Ultraprocessed food intake (servings/day), classified according to the NOVA system Outcomes CKD progression [≥50% decline in estimated glomerular filtration rate (eGFR) or initiation of kidney replacement therapy], all-cause mortality, and incident cardiovascular disease (myocardial infarction, congestive heart failure, or stroke). Analytical Approach Cox proportional hazards models adjusted for demographic, lifestyle, and health covariates. Results There were 1047 CKD progression events observed over a median follow-up of 7 years. Greater ultraprocessed food intake was associated with higher risk of CKD progression (tertile 3 vs. 1: HR 1.22, 95% CI: 1.04, 1.42; P-trend=0.01). The association differed by baseline kidney function, such that greater intake was associated with higher risk among people with CKD stages 1 and 2 (eGFR≥60 mL/min/1.73 m2; tertile 3 vs. 1: HR 2.61, 95% CI: 1.32, 5.18) but not stages 3a-5 (eGFR<60 mL/min/1.73 m2; P-interaction=0.003). There were 1104 deaths observed over a median follow-up of 14 years. Greater ultraprocessed food intake was associated with higher risk of mortality (tertile 3 vs. 1: HR 1.21, 95% CI: 1.04, 1.40; P-trend=0.004). Limitations Self-reported diet. Conclusions Greater ultraprocessed food intake may be associated with CKD progression in earlier stages of CKD, and is associated with higher risk of all-cause mortality in adults with CKD.