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Cited by 187Nutritional Studies and DietDialysis and Renal Disease ManagementChronic Kidney Disease and Diabetes

The associations of plant protein intake with all-cause mortality in CKD

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Chen, Xiaorui, Wei, Guo, Jalili, Thunder, Metos, Julie, Giri, Ajay, Cho, Monique E., Boucher, Robert, Greene, Tom +1 more·2016·American Journal of Kidney Diseases
DOI 10.1053/j.ajkd.2015.10.018PMC PMC4769135
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Abstract

Background Plant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease. Study design Observational study. Settings & participants 14,866 NHANES III participants 20 years or older without missing data for plant and animal protein intake and mortality. Predictors Plant protein to total protein ratio and total plant protein intake. Patients were stratified by estimated glomerular filtration rate (eGFR)<60 or ≥60mL/min/1.73m(2). Outcomes All-cause mortality. Measurements Plant and total protein intakes were estimated from 24-hour dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through December 31, 2000. Results Mean values for plant protein intake and plant protein to total protein ratio were 24.6±13.2 (SD) g/d and 33.0% ± 14.0%, respectively. The prevalence of eGFRs<60mL/min/1.73m(2) was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbid conditions, body mass index, calorie and total protein intake, and physical inactivity, each 33% increase in plant protein to total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR≥60mL/min/1.73m(2) subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR<60mL/min/1.73m(2) subpopulation. In sensitivity analyses, results were similar in those with eGFR<60mL/min/1.73m(2) defined by serum cystatin C level. Limitations Whether results are related to plant protein itself or to other factors associated with more plant-based diets is difficult to establish. Conclusions A diet with a higher proportion of protein from plant sources is associated with lower mortality in those with eGFR<60mL/min/1.73m(2). Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR<60mL/min/1.73m(2).

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  • Observational studies have reported that fruit and vegetable intake is associated with decline in progression of kidney disease.

    “fruit and vegetable intake were associated with decline in progression of kidney disease. 280 -282”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [280]

    The background passage under Abstract > Conclusions (page not provided) reports an observational finding that women with mild CKD who ate more animal protein had a greater decline in eGFR than those who ate more plant protein. The Methods say plant-protein sources include fruits and vegetables, but the paper does not report an association specifically between fruit and vegetable intake and slower kidney-disease progression. Its own study examined mortality, not progression. (LLM, conf=0.85)

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  • Observational studies have reported that high consumption of red and processed meat is associated with increased risk of CKD progression and mortality.

    “observational studies have reported that high consumption of red and processed meat is associated with increased risk of CKD progression and mortality”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [280]

    The introductory passage (page unavailable) reports an observational association between higher animal-protein intake and greater kidney-function decline in women with mild CKD. The Discussion (page unavailable) also reports an association between animal-protein intake and greater GFR loss. Neither passage identifies red or processed meat specifically, and the paper’s mortality finding concerns plant-protein intake rather than mortality risk from those meats. (LLM, conf=0.83)

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1 of the 63 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [4]National Kidney Foundation KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure 2000 35 6 suppl 1 S1 S140 10895784

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Authors
Chen, X., Wei, G., Jalili, T., Metos, J., Giri, A., Cho, M. E., Boucher, R., Greene, T., & Beddhu, S.
Affiliations
  • University of Utah (US)
  • VA Salt Lake City Healthcare System (US)
Corresponding author
Beddhu, Srinivasan
ORCID
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
2016-03
Volume
67
Issue
3
Pages
423-430
ISSN
0272-6386 (ISSN-L)
DOI
10.1053/j.ajkd.2015.10.018
PMC
PMC4769135
OpenAlex
W2195105306
Cited by
187
References
63
Citations by year
2026: 11 · 2025: 21 · 2024: 27 · 2023: 14 · 2022: 19 · 2021: 22 · 2020: 31 · 2019: 12 · 2018: 9 · 2017: 13 · 2016: 5 · 2015: 1
FWCI
9.90
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (RO1-DK077298, RO1-DK078112)
  • National Center for Research Resources (UL1-RR025764, C06-RR11234)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
plant protein intake, chronic kidney disease, all-cause mortality, estimated glomerular filtration rate, uremic toxins, serum phosphorus, plant-based diet, dietary protein
MeSH terms
Adult, Dietary Proteins, Feeding Behavior, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Male, Middle Aged, Mortality, Nutrition Surveys, Plant Proteins, Risk Factors, United States, Body Mass Index, Risk Assessment, Renal Insufficiency, Chronic, Cystatin C

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