Red meat intake and risk of ESRD
Open accessAbstract
Randomized controlled trials suggest that protein restriction may retard the progression of CKD toward ESRD. However, the effects of dietary protein intake level and the food sources of dietary protein on the risk of ESRD in the general population remain unclear. We investigated these effects in the Singapore Chinese Health Study, a prospective population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998. We collected habitual diet information via a validated semiquantitative food frequency questionnaire and identified ESRD via record linkage with a nationwide registry. In all, 951 cases of ESRD occurred over a mean follow-up of 15.5 years. Regarding total protein intake, compared with the lowest quartile, the three higher quartiles combined had a hazard ratio for ESRD of 1.24 (95% confidence interval [95% CI], 1.05 to 1.46), but the dose-dependent association across the quartiles was not statistically significant (P trend =0.16). Red meat intake strongly associated with ESRD risk in a dose-dependent manner (hazard ratio for highest quartile versus lowest quartile,1.40 [95% CI, 1.15 to 1.71; P trend <0.001]). Intake of poultry, fish, eggs, or dairy products did not associate with risk of ESRD. In substitution analysis, replacing one serving of red meat with other food sources of protein associated with a maximum relative risk reduction of 62.4% (95% CI, 33.1 to 78.9; P<0.01). Our study shows that red meat intake may increase the risk of ESRD…
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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 [282]
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 [282]
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“(28) reported nonsignificant associations of higher total protein intake and elevated disease risk, Malhotra et al.”
BackgroundLi, Y., Spence, J., Wang, X.-B., Huo, Y., Xu, X.-P., & Qin, X. (2020) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2019.07.020 · Cited by 26 · see citing works
Ebert, T., Painer, J., Bergman, P., Qureshi, A., Giroud, S., Stalder, G., Kublickiene, K., Göritz, F., Vetter, S. G., Bieber, C., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-76346-1 · Cited by 24 · see citing works
Protein Restriction for CKD: Time to Move On
Obeid, W., Hiremath, S., & Topf, J. (2022) · Kidney360 · doi:10.34067/kid.0001002022 · Cited by 23 · see citing works
Husain-Syed, F., Emlet, D. R., Wilhelm, J., Danesi, T., Ferrari, F., Bezerra, P., López-Giacoman, S. R., Villa, G., Tello, K., Birk, H., et al. (2022) · Journal of Translational Medicine · doi:10.1186/s12967-022-03410-x · Cited by 23 · see citing works
“Although patients with CKD are likely to exhibit progression to advanced stages more rapidly if they consume a high-protein diet over a prolonged period [27, 28], consistent with the hypothesis that the glomerular hemodynamic changes associated with persistent hyperfiltration accelerate glomerular injury [29], a short…”
BackgroundImpact of Dietary Protein on Osteoporosis Development
Kędzia, G., Woźniak, M., Samborski, W., & Grygiel-Górniak, B. (2023) · Nutrients · doi:10.3390/nu15214581 · Cited by 22 · see citing works
“It is suggested that replacing at least one portion of red meat per day with other protein sources may reduce this risk [12,13].”
BackgroundDiet in Chronic Kidney Disease: an integrated approach to nutritional therapy.
Pereira, R. A., Ramos, C. I., Teixeira, R. R., Muniz, G. A. S., Claudino, G., & Cuppari, L. (2020) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.66.s1.59 · Cited by 22 · see citing works
Protein supplementation: the double-edged sword
Patel, V., Aggarwal, K., Dhawan, A., Singh, B., Shah, P., Sawhney, A., & Jain, R. (2023) · Proceedings · doi:10.1080/08998280.2023.2280417 · Cited by 21 · see citing works
“67 A study conducted by Barsotti et al showed that as patients with nondiabetic nephrosis transitioned from an animal-vegetable diet (1.0 – 1.3 g/kg/day of protein) to a vegan diet (0.7 g/kg/day), there was a significant decrease in proteinuria.”
BackgroundInfluentialMao, T., Sun, Y., Xu, X., & He, K. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000234 · Cited by 24 · see citing works
“[ 140,141 ] Furthermore, a higher proportion of protein intake is associated with an increased risk of CVDs as mentioned above.”
BackgroundZhuang, Z.-H., Tong, M.-K., Clarke, R., Wang, B., Huang, T., & Li, L.-M. (2022) · Clinical Kidney Journal · doi:10.1093/ckj/sfac176 · Cited by 21 · see citing works
“Such an unhealthy diet may increase the risk of microalbuminuria and end-stage renal disease in the general population and substituting alternative sources of protein may reduce the incidence of renal disease [13].”
BackgroundKim, H., Kim, T. E., Han, M., Yi, Y.-J., Jeong, J., Chin, H. J., Song, S.-H.-O., Lee, J., Lee, K.-B., Sung, S.-A., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257305 · Cited by 21 · see citing works
“The proportion of red meat [51], or plant protein [52], which have been reported to play some role in renal progression would be different among diverse ethnic groups.”
Backgroundon behalf of CKD-REIN study investigators, Affret, A., Wagner, S., Fatouhi, D. E., Dow, C., Correia, E., Niravong, M., Clavel‐Chapelon, F., Chefdebien, J., Fouque, D. P., et al. (2017) · BMC Nephrology · doi:10.1186/s12882-017-0695-2 · Cited by 24 · see citing works
“[11] was validated, energy and deattenuated CC for nutrients ranged from 0.”
BackgroundSleep duration and risk of end-stage renal disease: the Singapore Chinese Health Study
Geng, T.-T., Jafar, T., Yuan, J.-M., & Koh, W. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.10.007 · Cited by 20 · see citing works
Self-citationHealthful dietary patterns and risk of end-stage kidney disease: the Singapore Chinese Health Study
Geng, T., Jafar, T. H., Neelakantan, N., Yuan, J., van Dam, R. M., & Koh, W. (2020) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa348 · Cited by 22 · see citing works
“For example, higher intakes of red meat (2, 3), total protein (4), sodium (5), and phosphorus (6) have been associated with a higher risk of kidney function decline, whereas higher intakes of dietary fiber (7), coffee (8, 9), and low-fat dairy have been associated with a lower risk of kidney function decline (10).”
BackgroundSelf-citationEslami, O., & Shidfar, F. (2018) · Nutrition (Burbank, Los Angeles County, Calif.) · doi:10.1016/j.nut.2018.03.047 · Cited by 18 · see citing works
Dietary Sources of Protein and Chronic Kidney Disease Progression: The Proof May Be in the Pattern.
Kelly, J., & Carrero, J. (2017) · Journal of renal nutrition · doi:10.1053/j.jrn.2017.04.001 · Cited by 18 · see citing works
Plant-based diets in patients with chronic kidney disease
Wathanavasin, W., Kittiskulnam, P., & Johansen, K. L. (2024) · Asian Biomedicine · doi:10.2478/abm-2024-0002 · Cited by 17 · see citing works
“Similarly, Lew et al. [29] revealed that red meat consumption was dose-dependently associated with higher risk of kidney failure, whereas substituting one serving of red meat with soy or legumes was associated with a 50.4% reduction in the risk of ESKD.”
BackgroundInfluentialHamed, L. A., & Aziz, T. M. A. (2020) · Egyptian Journal of Health Care · doi:10.21608/ejhc.2020.169731 · Cited by 17
“Approximately 5.1 million ESRF patients worldwide; rely on renal replacement therapy for better survival, that is either peritoneal dialysis, hemodialysis, or kidney transplantation, and this number is expected to double in the next decade (Lew et al., 2016).”
BackgroundInfluentialHeshmatifar, N., Salari, M., Rakhshani, M., Borzoee, F., & Sahebkar, M. (2020) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2020.101133 · Cited by 17
Xu, K., Cui, X., Wang, B., Tang, Q., Cai, J., & Shen, X. (2020) · BMC Nephrology · doi:10.1186/s12882-020-01918-2 · Cited by 23 · see citing works
Abdelhafiz, A. (2020) · Drugs & Aging · doi:10.1007/s40266-020-00773-y · Cited by 16 · see citing works
“Additionally, increased intake of red meat was strongly associated with an increasingly higher risk of ESRD in a dose-dependent manner [33].”
BackgroundGeng, T.-T., Talaei, M., Jafar, T., Yuan, J.-M., & Koh, W. (2019) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.119.013282 · Cited by 16 · see citing works
Self-citationKurniawan, A., Hsu, C.-Y., Rau, H.-H., Lin, L.-Y., & Chao, J. (2019) · Nutrix Journal · doi:10.1186/s12937-019-0467-x · Cited by 16 · see citing works
Galali, Y., Zebari, S. M. S., Jabbar, A. A., Balaky, H. H., Sadee, B., & Hassanzadeh, H. (2024) · Food Science & Nutrition · doi:10.1002/fsn3.3873 · Cited by 15 · see citing works
“Other studies have observed similar results (Lew et al., 2017 ; Mirmiran et al., 2020 ).”
ResultVegetarian Nutrition in Chronic Kidney Disease
Narasaki, Y., Kalantar‐Zadeh, K., Rhee, C. M., Brunori, G., & Zarantonello, D. (2023) · Nutrients · doi:10.3390/nu16010066 · Cited by 22 · see citing works
“A report from the Singapore Chinese Health Study showed the deleterious impact of high red meat intake on progression to ESKD, and it also showed that substituting one serving of red meat with one serving of soy/legumes was associated with a lower risk of incident ESKD [69].”
BackgroundDiet and Proteinuria: State of Art
Ria, P., Pascalis, A. D., Zito, A., Barbarini, S., Napoli, M., Gigante, A., & Sorice, G. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms24010044 · Cited by 15 · see citing works
Sharma, M., Singh, V., Sharma, R., Koul, A., McCarthy, E., Savin, V., Joshi, T., & Srivastava, T. (2022) · Biomedicines · doi:10.3390/biomedicines10020407 · Cited by 15 · see citing works
Egg Intake in Chronic Kidney Disease
Tallman, D. A., Sahathevan, S., Karupaiah, T., & Khosla, P. (2018) · Nutrients · doi:10.3390/nu10121945 · Cited by 15 · see citing works
Michail, A., & Andreou, E. P. (2025) · Nutrients · doi:10.3390/nu17060970 · Cited by 14 · see citing works
“A possible reason could be due to acid production upon metabolizing red meat, which results in an increase in uremic toxins produced and an increase in inflammation markers ( C -reactive protein (CRP), interleukin 6 (IL-6), p -cresyl sulfate, and TNF-a), as well as oxidative stress [51,52].”
de Lorenzo, A., Bomback, A. S., & Mihic, N. (2024) · Sports Medicine · doi:10.1007/s40279-024-02086-1 · Cited by 17 · see citing works
“Substituting one serving of red meat with a plant-based protein such as legumes was associated with a 31–62.4% reduced risk of CKD [80, 81].”
InfluentialWhat is central to renal nutrition: protein or sodium intake?
Wang, A., Mallamaci, F., & Zoccali, C. (2023) · Clinical Kidney Journal · doi:10.1093/ckj/sfad151 · Cited by 14 · see citing works
“Replacing one serving of red meat intake with other food sources of protein was associated with a maximum relative risk reduction of kidney failure of 62% [ 61 ].”
BackgroundInfluential
- Authors
- Lew, Q.-L. J., Jafar, T. H., Koh, H. W. L., Jin, A., Chow, K. Y., Yuan, J.-M., & Koh, W.-P.
- Affiliations
- SingHealth Polyclinics (SG)
- Singapore General Hospital (SG)
- National University of Singapore (SG)
- Health Promotion Board (SG)
- University of Pittsburgh (US)
- Corresponding author
- Lew, Quan-Lan Jasmine
- Yuan, Jian-Min
- Venue
- Journal of the American Society of Nephrology
- Published
- 2016-07-14
- Volume
- 28
- Issue
- 1
- Pages
- 304-312
- ISSN
- 1046-6673 (ISSN-L)
- 1533-3450
- PMC
- PMC5198288
- OpenAlex
- W2464978253
- Cited by
- 222
- References
- 0
- Citations by year
- 2026: 9 · 2025: 19 · 2024: 26 · 2023: 31 · 2022: 28 · 2021: 23 · 2020: 33 · 2019: 16 · 2018: 17 · 2017: 15 · 2016: 4
- FWCI
- 17.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Society of Nephrology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National University of Singapore
- National Cancer Institute (R01CA144034, R01CA080205, UM1CA182876)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
- Keywords
- red meat consumption, end-stage renal disease, protein intake, protein restriction, chronic kidney disease progression, protein source substitution, poultry, fish, eggs, dairy products, dose-response relationship, Singapore Chinese Health Study
- MeSH terms
- Red Meat, Aged, Female, Humans, Kidney Failure, Chronic, Male, Middle Aged, Prospective Studies, Risk Factors
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