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

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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, Beddhu, Srinivasan·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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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: Chen, Xiaorui
Jalili, Thunder
Metos, Julie
Giri, Ajay
Cho, Monique E.
Boucher, Robert
Greene, Tom
Beddhu, Srinivasan
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
FWCI: 9.90
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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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The Associations of Plant Protein Intake With All-Cause Mortality in CKD

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