Dietary pattern may not impact mortality for patients on hemodialysis
After conducting a prospective cohort study, researchers found “no evidence” of an association between fruit- and vegetable-based or Western dietary patterns on mortality in adults receiving hemodialysis.
“Dietary patterns, such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets, are associated with a 10% to 30% reduction in cardiovascular events and mortality,” Valeria M. Saglimbene, MScMed, of the Sydney School of Public Health at the University of Sydney in Australia, and colleagues wrote. “However, these dietary patterns have not been shown to be associated with improved survival in hemodialysis patients. [In addition], dietary guidelines suggest modifying the intake of individual nutrients in dialysis patients to control serum phosphate and potassium levels and fluid overload while maintaining a high protein and energy intake, [but] there is limited high-certainty evidence showing that targeting single nutrients improves clinical outcomes.”
Research teams led by Saglimbene have conducted previous analyses of the Dietary Intake, Death and Hospitalization in Adults with ESKD Treated with Hemodialysis (DIET-HD) study in which they examined associations between the Mediterranean and DASH diets with survival among hemodialysis patients, as well as associations between fruit and vegetable intake and mortality. They also used data from DIET-HD this time to evaluate the association between a fruit- and vegetable-based diet and a Western diet with mortality.
Dietary patterns were established through responses to a food frequency questionnaire, with the fruit- and vegetable-based diet consisting of higher intakes of fruit and vegetables and the Western diet consisting of a higher intake of Western style foods (eg, French fries, eggs, red and processed meat).
A total of 8,110 participants were followed for a median of 2.7 years. During this time, 2,087 deaths occurred (958 from cardiovascular diseases).
For the fruit and vegetable dietary pattern, researchers found that compared with patients in the lowest quartile of the fruit and vegetable dietary pattern score, adjusted HRs in the other quartiles (ascending order) were 0.94, 0.83 and 0.91 for cardiovascular mortality. For all-cause mortality, adjusted HRs were 0.95, 0.84 and 0.87.
Regarding the Western dietary pattern, researchers observed adjusted HRs of 1.10, 1.11 and 1.09 for cardiovascular mortality and of 1.01, 1 and 1.14 for all-cause mortality.
Researchers hypothesized that the lack of association between the two dietary patterns and mortality may be due to the fact that the impact of kidney disease (and its comorbid conditions) is so profound that factors such as diet have “substantially smaller absolute effects on mortality in dialysis patients” than these have on the general population.
“These findings of little or no association of dietary patterns with mortality outcomes added to the uncertain benefits of restricting single dietary components leads to the conclusion that further investigation of dietary recommendations in hemodialysis is warranted,” they wrote. “This is especially relevant given the substantial adverse impact that dietary restrictions have on quality of life. Future trials should investigate whether a more liberal approach to the intake of fruit and vegetables or dietary control can offer similar survival and improved quality of life for patients treated with long-term hemodialysis.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.