地中海饮食与肾移植受者的肾功能丧失。

Mediterranean Style Diet and Kidney Function Loss in Kidney Transplant Recipients.

机构信息

Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and.

Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.

出版信息

Clin J Am Soc Nephrol. 2020 Feb 7;15(2):238-246. doi: 10.2215/CJN.06710619. Epub 2020 Jan 2.

DOI:10.2215/CJN.06710619

PMID:31896540

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7015079/

Abstract

BACKGROUND AND OBJECTIVES

Despite improvement of short-term graft survival over recent years, long-term graft survival after kidney transplantation has not improved. Studies in the general population suggest the Mediterranean diet benefits kidney function preservation. We investigated whether adherence to the Mediterranean diet is associated with kidney outcomes in kidney transplant recipients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We included 632 adult kidney transplant recipients with a functioning graft for ≥1 year. Dietary intake was inquired using a 177-item validated food frequency questionnaire. Adherence to the Mediterranean diet was assessed using a nine-point Mediterranean Diet Score. Primary end point of the study was graft failure and secondary end points included kidney function decline (doubling of serum creatinine or graft failure) and graft loss (graft failure or death with a functioning graft). Cox regression analyses were used to prospectively study the associations of the Mediterranean Diet Score with study end points.

RESULTS

During median follow-up of 5.4 (interquartile range, 4.9-6.0) years, 76 participants developed graft failure, 119 developed kidney function decline, and 181 developed graft loss. The Mediterranean Diet Score was inversely associated with all study end points (graft failure: hazard ratio [HR], 0.68; 95% confidence interval [95% CI], 0.50 to 0.91; kidney function decline: HR, 0.68; 95% CI, 0.55 to 0.85; and graft loss: HR, 0.74; 95% CI, 0.63 to 0.88 per two-point increase in Mediterranean Diet Score) independent of potential confounders. We identified 24-hour urinary protein excretion and time since transplantation to be an effect modifier, with stronger inverse associations between the Mediterranean Diet Score and kidney outcomes observed in participants with higher urinary protein excretion and participants transplanted more recently.

CONCLUSIONS

Adherence to the Mediterranean diet is associated with better kidney function outcomes in kidney transplant recipients.

摘要

背景与目的

尽管近年来短期移植物存活率有所提高，但肾移植后的长期移植物存活率并未改善。普通人群的研究表明，地中海饮食有益于保护肾功能。我们研究了地中海饮食的依从性与肾移植受者的肾脏结局之间的关系。

设计、地点、参与者和测量：我们纳入了 632 名移植后至少 1 年肾功能正常的成年肾移植受者。通过 177 项验证的食物频率问卷来调查饮食摄入情况。采用九点地中海饮食评分来评估地中海饮食的依从性。研究的主要终点是移植物失功，次要终点包括肾功能下降（血清肌酐加倍或移植物失功）和移植物丢失（移植物失功或带功能移植物的死亡）。使用 Cox 回归分析前瞻性研究地中海饮食评分与研究终点的关系。

结果

在中位随访 5.4 年（四分位间距，4.9-6.0 年）期间，76 名患者发生移植物失功，119 名患者发生肾功能下降，181 名患者发生移植物丢失。地中海饮食评分与所有研究终点均呈负相关（移植物失功：风险比[HR]，0.68；95%置信区间[95%CI]，0.50 至 0.91；肾功能下降：HR，0.68；95%CI，0.55 至 0.85；以及移植物丢失：HR，0.74；95%CI，0.63 至 0.88，每增加两个点地中海饮食评分），独立于潜在的混杂因素。我们发现 24 小时尿蛋白排泄和移植时间是一个效应修饰因素，在尿蛋白排泄较高和最近移植的患者中，地中海饮食评分与肾脏结局之间的负相关关系更强。