Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
J Ren Nutr. 2023 Jul;33(4):566-574. doi: 10.1053/j.jrn.2023.01.011. Epub 2023 Feb 13.
Patients with advanced chronic kidney disease (CKD) are generally discouraged from consuming high amounts of vegetables and fruits given the potential risk of hyperkalemia. In the general population, however, lower vegetable and fruit intake is associated with higher mortality. This Japanese hospital-based prospective cohort study including non-CKD and CKD participants examined whether the frequency of vegetable and fruit intake is associated with mortality, and whether the presence of CKD modifies this association.
Participants were 2,006 patients who visited the outpatient department of a general hospital between June 2008 and December 2016 (55% men; mean age, 69 years). Among these participants, 902 (45%) and 131 (7%) were non-dialysis-dependent patients with CKD and hemodialysis patients, respectively. The frequency of vegetable and fruit intake was determined by a self-report questionnaire using an ordinal scale, "never or rarely," "sometimes," and "every day." Multivariable Cox proportional hazards analysis was conducted, adjusting for potential confounders.
Vegetable and fruit intake frequency decreased with worsening CKD stage (P for trend < .001). Baseline serum potassium levels stratified by CKD stage were similar across the three vegetable and fruit intake frequency groups. During a median follow-up of 5.7 years, 561 participants died (47.1/1,000 person-years). Adjusted hazard ratios relative to the "every day" group were 1.25 (95% confidence interval, 1.04-1.52) and 1.60 (95% confidence interval, 1.23-2.08) for the "sometimes" and "never or rarely" groups, respectively, after adjusting for demographic factors, comorbidities, and CKD status. When stratified by CKD status, a similar, albeit non-significant, dose-dependent relationship was observed between vegetable and fruit intake frequency and all-cause mortality irrespective of CKD status, with no effect modification by CKD status (P = .69).
A lower frequency of vegetable and fruit intake is significantly associated with a higher risk of death regardless of CKD status.
患有晚期慢性肾脏病（CKD）的患者通常被劝阻摄入大量的蔬菜和水果，因为这可能会导致高钾血症的风险。然而，在一般人群中，蔬菜和水果摄入量较低与死亡率较高有关。这项基于日本医院的前瞻性队列研究包括非 CKD 和 CKD 参与者，研究了蔬菜和水果的摄入频率是否与死亡率相关，以及 CKD 是否会改变这种关联。
参与者为 2006 名于 2008 年 6 月至 2016 年 12 月间在综合医院门诊就诊的患者（55%为男性；平均年龄为 69 岁）。其中，902 名（45%）为非透析依赖型 CKD 患者，131 名（7%）为血液透析患者。蔬菜和水果的摄入频率通过使用 ordinal 量表的自我报告问卷来确定，分为“从不或很少”、“有时”和“每天”。采用多变量 Cox 比例风险分析，调整了潜在的混杂因素。
蔬菜和水果的摄入频率随着 CKD 阶段的恶化而降低（趋势 P<0.001）。按 CKD 阶段分层的基线血清钾水平在三组蔬菜和水果摄入频率组中相似。在中位数为 5.7 年的随访期间，561 名参与者死亡（47.1/1000 人年）。与“每天”组相比，“有时”和“从不或很少”组的调整后危险比分别为 1.25（95%置信区间，1.04-1.52）和 1.60（95%置信区间，1.23-2.08），调整了人口统计学因素、合并症和 CKD 状况。按 CKD 状况分层后，无论 CKD 状况如何，蔬菜和水果摄入频率与全因死亡率之间均存在类似的、尽管无统计学意义的剂量依赖性关系，且 CKD 状况无明显的效应修饰作用（P=0.69）。
无论 CKD 状况如何，蔬菜和水果摄入频率较低与死亡风险增加显著相关。
