Associations of low-carbohydrate with mortality in chronic kidney disease

Abstract

Background

Diet management is an effective way to retard the progression of chronic kidney disease (CKD). However, very few studies investigated the influence of carbohydrate intake on CKD patients. In this prospective cohort study, the associations between carbohydrate intake and all-cause mortality were investigated in US adult CKD patients.

Methods

Multivariable Cox proportional hazard models and iso-caloric replacement analysis were used to investigate the associations between the macronutrients and the all-cause mortality risk. Total 3683 US adult CKD patients 20 years or older from the National Health and Nutrition Examination Survey (NHANES, 2003–2014) were analyzed (mean age ± SD, 62.4 ± 17.1; 56.5% female), of which 1082 participants with CKD died with a median follow-up time of 67 (IQR 36–99) months.

Results

Most macronutrients were non-linearly associated with all-cause mortality risk, including carbohydrates and sugar. Participants with CKD had lower mortality risk when consuming 30–45% energy from carbohydrates (average HR 0.76, 95%CI 0.62–0.93, compared with 60%), 5–20% energy from sugar (average HR 0.75, 95% CI 0.59–0.96 compared with 40%). Replacing the energy intake from carbohydrates with protein (up to 30%) and/or replacing the sugar with non-sugar carbohydrates (up to 55%) reduced the all-cause mortality risk, while the total energy intake remained constant.

Conclusions

Diet advice should be given according to the current diet status, and constituents of carbohydrates should also be taken into consideration.

Keywords:

• Chronic kidney disease
• low carbohydrate diet
• mortality

Ethics approval and consent to participate

The ethics approval was made by NCHS Research Ethics Review Board (ERB). Details are available at [https://www.cdc.gov/nchs/nhanes/irba98.htm].

Authors’ contributions

QR & YZ & XL designed research; QR & YZ & HL & GC conducted research and analyzed data; YH & KZ & YQ helped with data cleaning and statistical analysis; QR & YZ & HL & GC wrote the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets analyzed during the current study are available at [https://wwwn.cdc.gov/nchs/nhanes/Default.aspx].

Additional information

Funding

Yangzhong Zhou was supported by the National Natural Sciences Foundation of China (grant no. 81801632), no restrictions were involved regarding publication.