Cited by 222Nutritional Studies and DietChronic Kidney Disease and DiabetesAgriculture Sustainability and Environmental Impact

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Red Meat Intake and Risk of ESRD

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Lew, Quan-Lan Jasmine, Jafar, Tazeen Hasan, Koh, Hiromi Wai Ling, Jin, Aizhen, Chow, Khuan Yew, Yuan, Jian-Min, Koh, Woon-Puay·2017·Journal of the American Society of Nephrology

DOI 10.1681/asn.2016030248PMC PMC5198288

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Abstract

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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Items 101–187 of 187

Dietary Patterns Based on Estimated Glomerular Filtration Rate and Kidney Function Decline in the General Population: The Lifelines Cohort Study
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Background
Medical nutrition therapy and dietary counseling for patients with diabetes-energy, carbohydrates, protein intake and dietary counseling
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Background
Sex modulates the association of fibroblast growth factor 21 with end‐stage renal disease in Asian people with Type 2 diabetes: a 6.3‐year prospective cohort study
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Influential
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Pradhan, N., & Dobre, M. A. (2023) · Current Atherosclerosis Reports · doi:10.1007/s11883-023-01172-5 · Cited by 14
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Babich, J. S., Dupuis, L., Kalantar-Zadeh, K., & Joshi, S. (2023) · Advances in kidney disease and health · doi:10.1053/j.akdh.2023.10.001 · Cited by 10
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Background
A Plant-Based Diet Prevents and Treats Chronic Kidney Disease
Rose, S. D. (2019) · JOJ Urology & Nephrology · doi:10.19080/jojun.2018.06.555687 · Cited by 11
“alternative sources of protein may reduce the incidence of ESRD [33].”
BackgroundInfluential
Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology
Qian, Q. (2018) · Nutrients · doi:10.3390/nu10060778 · Cited by 11
“A good supportive example is the recent population study from Singapore (the Singapore Chinese Health Study, n = 63,257), which showed a lower risk of renal failure in those adhering to a diet rich in soy and legumes than those with diets heavy in red meats [100].”
Background
Protective Effects of the Food Supplement Flexovital in a Model of Cardiovascular-Kidney-Metabolic Syndrome in Mice
Carvalho, L. R. R. A., Tydén, M., Shimari, M., Zhuge, Z., Schiffer, T. A., Monteiro, M. M. D. O., Lundberg, J. O., Weitzberg, E., Andersson, D. C., Fellström, B., et al. (2024) · Nutrients · doi:10.3390/nu16234105 · Cited by 8
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Result
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Valle-Hita, C., Becerra-Tomás, N., Díaz-López, A., Vázquez-Ruiz, Z., Megías, I., Corella, D., Goday, A., Martinez, J., Alonso-Gómez, Á., Warnberg, J., et al. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.986190 · Cited by 8
“It should be noted that in our study individuals with high levels of dietary acid load reported higher intakes of some food groups which have been directly or indirectly implicated in kidney function damage, such as total and animal protein intake (33, 45) or sugar and sweetened products (46).”
Background
The Pre-Dialysis Care Trajectory of Chronic Kidney Disease Patients and the Start of Dialysis in Emergency: A Mixed Method Study Protocol
Raffray, M., Bayat, S., Campéon, A., Laude, L., & Vigneau, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16245010 · Cited by 8
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“Moreover, reduced intake of red and processed meat contributes to a reduction of dietary sodium and phosphorus, which may have a positive effect on CKD progression [15].”
Background
Meat intake and risk of mortality and graft failure in kidney transplant recipients
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Preliminary Study on Pasta Samples Characterized in Antioxidant Compounds and Their Biological Activity on Kidney Cells
Marco, F. D., Trevisani, F., Vignolini, P., Urciuoli, S., Salonia, A., Montorsi, F., Romani, A., Vago, R., & Bettiga, A. (2021) · Nutrients · doi:10.3390/nu13041131 · Cited by 9
Improving Nutrition Research in Nephrology: An Appetite for Change.
Campbell, K., Palmer, S., & Johnson, D. (2017) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2017.02.006 · Cited by 7
Is Dietary Red Meat Kidney Toxic?
Goraya, N., & Wesson, D. (2017) · Journal of the American Society of Nephrology · doi:10.1681/asn.2016060664 · Cited by 7
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Revisiting glomerular hyperfiltration and examining the concept of high dietary protein-related nephropathy in athletes and bodybuilders
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“This may lower DQ as, depending on how these foods are prepared, they may be high in saturated fats and sodium [12,20,21].”
Background
The impact of diabetes on the association between alcohol intake and the risk of end‐stage kidney disease in the Singapore Chinese Health Study
Geng, T.-T., Jafar, T., Yuan, J.-M., & Koh, W. (2020) · Journal of Diabetes · doi:10.1111/1753-0407.13034 · Cited by 6
Self-citation
Dietary Patterns and Kidney Health: An Umbrella Review of Systematic Reviews and Meta-Analyses
Li, J., Yang, L., Yang, B., Liu, C., Wei, W., Huang, Y., Ren, J., Wang, B., Ma, L., Zhang, L., et al. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf208 · Cited by 6
Dietary Patterns, Apolipoprotein L1 Risk Genotypes, and CKD Outcomes Among Black Adults in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study
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Bardhi, O., Clegg, D. J., & Palmer, B. F. (2023) · Seminars in Nephrology · doi:10.1016/j.semnephrol.2023.151406 · Cited by 7
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Masi, D., Risi, R., Basciani, S., Tuccinardi, D., Mariani, S., Lubrano, C., Gnessi, L., & Watanabe, M. (2020) · Journal of renal nutrition · doi:10.1053/j.jrn.2020.09.001 · Cited by 5
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“20 Several studies have shown that dietary or lifestyle interventions can improve health-related quality of life and eGFR in patients with CKD. 21,22 Public health strategies should consider screening for CKD and its associated risk factors so that intensive intervention can reduce these risk…”
Background
The Impact of a Mediterranean-like Diet with Controlled Protein Intake on the Onco-Nephrological Scenario: Time for a New Perspective
Bettiga, A., Fiorio, F., Liguori, F., di Marco, F., Quattrini, G., Vago, R., Giannese, D., Salonia, A., Montorsi, F., & Trevisani, F. (2022) · Nutrients · doi:10.3390/nu14235193 · Cited by 4
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Lv, D., Wang, T.-T., Fan, J., Hong, D., Chen, Z., Xu, Q.-C., Zhou, D., & Xie, X.-S. (2026) · The Journal of Nutrition, Health & Aging · doi:10.1016/j.jnha.2026.100777 · Cited by 3
“First, limiting animal protein intake, particularly from red meat, may reduce the production of the harmful catabolic by-products of protein metabolism, thereby decreasing chronic inflammation, oxidative stress, and endothelial dysfunction [36,37].”
The Effect of Protein Intake on Bone Disease, Kidney Disease, and Sarcopenia: A Systematic Review
Lamina, T., Brandt, S., Abdi, H., Yam, H., Hayi, A. G., Parikh, R. R., Kirkland, C., Claussen, A. M., Burstad, K. M., Slavin, J. L., et al. (2025) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2025.104546 · Cited by 3
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Ding, Z., Wu, X.-Z., Liu, C., Ying, R., Zhang, Y., Zhang, S., Zhang, Q.-H., Hu, H.-L., & Dai, F. (2023) · Journal of human nutrition and dietetics (Print) · doi:10.1111/jhn.13245 · Cited by 3
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Sun, J., Wei, Y., Miao, R., Zhang, X., Zhang, B., Zhang, L., & Zhao, L. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1184337 · Cited by 4
“Red meat consumption was strongly associated with ESRD risk in a dose-dependent manner, whereas other proteins, such as fish, did not show such deleterious associations (12).”
Background
Evaluation of hemodialysis adequacy using urea reduction rate and related factors in Iranian patients’ undergoing hemodialysis in Guilan, Iran
Yaseri, M., Fayazi, H. S., Khatibani, S. S. M., & Hajipoor, A. (2023) · Journal of Renal Injury Prevention · doi:10.34172/jrip.2023.32132 · Cited by 3
“End-stage renal disease (ESRD) is the final stage of chronic kidney disease and is defined as the stage that requires renal replacement therapy or hemodialysis (3).”
Background
Exploring mHealth potential to improve kidney function: secondary analysis of a randomized trial of diabetes self-care in diverse adults
Roddy, M. K., Mayberry, L. S., Nair, D., & Cavanaugh, K. L. (2022) · BMC Nephrology · doi:10.1186/s12882-022-02885-6 · Cited by 5
Low variability of plant protein intake in the CKiD cohort does not demonstrate changes in estimated GFR nor electrolyte balance
Shah, L. N., Matheson, M. B., Furth, S. L., Schwartz, G. J., Warady, B. A., & Wong, C. J. (2021) · Pediatric Nephrology · doi:10.1007/s00467-021-05334-y · Cited by 3
Nutritional behavior in Italian and immigrant children
Collo, A., Ferro, A., Belci, P., Cerutti, F., Rabbone, I., Ignaccolo, M. G., Carletto, G., Vallini, C., Cadario, F., Savastio, S., et al. (2019) · Minerva Pediatrics · doi:10.23736/s0026-4946.19.05654-8 · Cited by 3
Association Between the Planetary Health Diet Index and Chronic Kidney Disease Prevalence and Mortality: An Analysis of NHANES 2005–2018
Ming, Y., Sun, Z.-H., Tao, M., Yang, J., Li, S.-Y., Tao, X., Wang, H.-Y., Qu, C., & Liu, Z. (2025) · Food Science & Nutrition · doi:10.1002/fsn3.71402 · Cited by 2
“Saturated fat and processed meat intake are related to faster renal decline, whereas consumption patterns rich in vegetables, fruits, whole grains, and unsaturated fats are associated with slower progression (Carrero et al. 2020; Kelly et al. 2021; Lew et al. 2017; Hu et al. 2019; Cai et al. 2021).”
Dietary intake of total, animal, and plant proteins and risk of chronic kidney disease: systematic review and dose-response meta-analysis of prospective cohort studies
Talebi, S., Majd, S. S., Zeraattalab-Motlagh, S., Rahimlou, M., & Mohammadi, H. (2025) · BMC Nutrition · doi:10.1186/s40795-025-01204-0 · Cited by 2
“However, further research is needed to fully understand the role of different dietary protein sources and their non-protein constituents in this process [5, 11–13].”
Influential
Management of hypertension in specific populations: a review
Koirala, A., Gautam, S. C., & Aslam, A. (2025) · Annals of Translational Medicine · doi:10.21037/atm-25-65 · Cited by 2
“Although low-potassium diets may be recommended for chronic hyperkalemia, potassium-rich foods have various health benefits and may help slow CKD (81,82) and cardiovascular disease progression (83-85).”
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“However, human studies suggest that a high-protein diet may increase the risk of chronic kidney disease (53), with daily consumption of red meat posing a higher risk (54).”
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BackgroundInfluential
High Alternative Health Eating Index-Taiwan Scores Are Associated With Prevention of Graft Dysfunction in Taiwanese Renal Transplant Recipients
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Progressionsverlangsamung – Rolle von Ernährung und Flüssigkeitszufuhr
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“13 Living kidney donor, n (%) 216 (34) 0.”
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Vegetarian Dietary Patterns and Diet-Related Metabolites Are Associated With Kidney Function in the Adventist Health Study-2 Cohort
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“Furthermore, when the study by Lew et al. (44) is British Journal of Nutrition removed, the previously established significant positive association between consuming red meat and the risk of CKD becomes non-significant.”
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Predictors of self-care in kidney transplant patients according to preoperative dialysis: A comparative study
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Association between Diet-Related Greenhouse Gas Emissions and Mortality among Japanese Adults: The Japan Collaborative Cohort Study
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“…change in GHGE level associated with the replacement of one serving of red meat (beef, pork, or liver) with one serving of an alternative protein source was calculated using the substitution method 24,25 because reducing meat consumption may bene ﬁ t both a reduction in GHGEs and health outcomes.”
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“There was a strong dose-dependent relationship with red meat intake and increased risk of ESRD [47].”
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Impact of dietary habits on renal function in Saku, a rural Japanese town: a cohort study
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“Red meat is reported to be more likely to aggravate kidney function than white meat, although there was no association between chicken intake and ESRD [20].”
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“of red meat was dose-dependently associated with the risk of end-stage renal failure, but conversely, intake of egg, fish, chicken, and dairy products was involved in reducing the risk [13].”
Background
[Low protein diet supplemented with ketoanalogues of amino acids in patients with chronic renal insufficiency].
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High-Protein Diets: What to Tell Our Patients
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Gu, J., & Zhang, J.-Y. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1666684
Associations of Dietary Protein Intake and Amino Acid Patterns with the Risk of Diabetic Kidney Disease in Adults with Type 2 Diabetes: A Cross-Sectional Study
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“Appropriate supplementation with BCAAs and histidine and restriction of tyrosine, methionine, and glutamic acid may serve as nutritional strategies to support kidney function [29,30].”
Fad diets for non-dialysis chronic kidney disease patients: Can “the miracle diet” be a threat?
Brum, I. D. S. D. C., Cardozo, L., Alvarenga, L., Kemp, J. A., Baptista, B. G., Britto, I. K., Borges, N. A., Renouf, D., Wong, M., Fouque, D. P., et al. (2024) · Nutrition · doi:10.1016/j.nut.2024.112668 · Cited by 2
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“[ 33] According to research, replacing one serving of red meat with soy or legumes is linked to a 50.4% lower risk of kidney failure.”
MethodInfluential
The Risk of Excess Lamb Meat (Mutton Meat) Consumption on the Emergence of Ischemic Heart Diseases and other Related Health Problems in Habitants of North Sinai Governorate
KARIMA YOUSSEF AHMED, M. D. A. M. A. H. A. (2024) · The Medical journal of Cairo University · doi:10.21608/mjcu.2024.389771
Dietetic-nutritional management strategies for patients with chronic kidney disease
Zheng, Q. (2023) · Highlights in Science Engineering and Technology · doi:10.54097/tc9p6070
Pre‐bariatric surgery acute kidney injury: Can this be prevented?
Leelaviwat, N., Yingchoncharoen, P., Thongpiya, J., Abdelnabi, M. H., & Mekraksakit, P. (2023) · Clinical Case Reports · doi:10.1002/ccr3.8070
Is high protein intake a real concern for healthy kidneys?
Giannese, D., Panichi, V., & Cupisti, A. (2022) · Journal of Nephrology · doi:10.1007/s40620-022-01503-w
“In the general population of the Singapore Chinese Health Study, consumption of red meat was associated with higher end stage renal disease risk in a dose-dependent manner whereas it did not occur for poultry, fish, eggs, or dairy products [7].”
Background
Empirical Effect of Nutritional Awareness and Calciferol Supplementation in Renal Patients
Hamid, F., Mohamed, M., El-Sayed, H., Ibrahim, N. M., Elsawy, G., El-Fattah, N. A., & Ahmad, E. M. (2022) · Bulletin of the National Nutrition Institute of the Arab Republic of Egypt · doi:10.21608/bnni.2022.244348
“Lew QLJ; Jafar TH; Koh HWL; Jin A; Chow KY; Yuan JM and Koh WP (2017): Red meat intake and risk of ESRD.”
Background
Association between Frequency of Consumption of Pork Se’i and Chronic Kidney Disease in East Nusa Tenggara, Indonesia
Wahyuni, M., Haliman, C. D., Melaniani, S., & Mahmudiono, T. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.7330
“Studies showed that higher intake of red and processed meat was significantly associated with an increased risk for incident CKD [6], [7].”
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Nutrition and Diet Therapy for DKD
Kume, S. (2020) · Springer eBooks · doi:10.1007/978-981-15-9301-7_7
Association of Dietary Patterns with Some Risk Biomarkers of Chronic Kidney Disease of Saudi Patients
Khogali, F. (2020) · Journal of Advance Research in Applied Science · doi:10.53555/nnas.v7i1.819
“(15) stated that red meat intake strongly associated with ESRD risk.”
Background
Do You Have Any Risk Factors or Long-Term Health Conditions? How Environment, Lifestyle and Other Medical Conditions Are Linked to Kidney Disease
Rayner, H., Thomas, M. E., & Milford, D. (2020) · Springer eBooks · doi:10.1007/978-3-030-43027-6_6
Dietary Patterns
Kelly, J. T. (2020) · Springer eBooks · doi:10.1007/978-3-030-44858-5_31

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
ORCID: Jafar, Tazeen Hasan
Koh, Hiromi Wai Ling
Jin, Aizhen
Yuan, Jian-Min
Koh, Woon-Puay
Venue: Journal of the American Society of Nephrology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-07-14
Volume: 28
Issue: 1
Pages: 304-312
ISSN: 1046-6673 (ISSN-L)
1533-3450
DOI: 10.1681/asn.2016030248
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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Red Meat Intake and Risk of ESRD

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