Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Rationale & ObjectiveStudies have shown that generally healthy individuals who consume diets rich in plant foods have a lower risk of incident chronic kidney disease (CKD) and cardiovascular disease. This study investigated the prospective associations of plant-based diets with the risk of CKD progression and all-cause mortality in patients with CKD.Study DesignProspective cohort study.Setting & Participants2,539 participants with CKD recruited between 2003 – 2008 into the Chronic Renal Insufficiency Cohort (CRIC) study.ExposuresResponses on the Diet History Questionnaire were used to calculate scores for the overall plant-based diet index, healthy plant-based diet index, and unhealthy plant-based diet index.Outcomes(1) CKD progression defined as ≥50% estimated glomerular filtration rate decline from baseline or kidney replacement therapy (dialysis, transplant), (2) all-cause mortality.Analytical ApproachCox proportional hazards models to compute hazard ratios (HR) and 95% confidence intervals (95% CI) adjusting for lifestyle, socioeconomic, and clinical covariates.ResultsThere were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively. Participants with the highest vs. lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR: 0.74, 95% CI: 0.62, 0.88, p-trend<0.001) and 21% (HR: 0.79, 95% CI: 0.66, 0.95, p-trend=0.03) lower risks of all-cause mortality, respectively. Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR: 1.14, 95% CI: 1.03, 1.25) and all-cause mortality (HR: 1.11, 95% CI: 1.00 to 1.23).LimitationsSelf-reported diet may be subject to measurement error.ConclusionsAdherence to an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among individuals with CKD. An unhealthy plant-based was associated with an elevated risk of CKD progression and all-cause mortality.