Pradhan Nishigandha, Delozier Sarah, Brar Sumeet, Perez Jaime Abraham, Rahman Mahboob, Dobre Mirela
Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Cleveland Medical Center, Cleveland, Ohio.
Clinical Research Unit, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
J Ren Nutr. 2025 Jan;35(1):110-117. doi: 10.1053/j.jrn.2024.07.014. Epub 2024 Jul 27.
Dietary interventions are the mainstay of chronic diseases prevention in general population, but the evidence to support such therapeutic approaches in patients with chronic kidney disease (CKD) is less robust. The objective of this study is to examine the association between dietary fiber intake and adverse cardiovascular and kidney outcomes and all-cause mortality in participants with CKD enrolled in the Chronic Renal Insufficiency Cohort study.
A total of 3791 Chronic Renal Insufficiency Cohort participants with self-reported dietary fiber intake were included in the analyses stratified by tertiles of dietary fiber at study baseline. Hazard ratios for occurrence of all-cause mortality, composite cardiovascular events and composite kidney events were calculated using Cox Proportional Hazards models adjusted for demographic, clinical, and laboratory characteristics, including levels of inflammatory markers, C-reactive protein and interleukin-6.
Mean daily dietary fiber intake was 15.2 g/day. During a median (standard deviation) follow up of 14.6 (4.4) years, 1074 deaths from any cause occurred. In multivariable adjusted models, participants in the middle and low dietary fiber tertiles had a 19% (hazard ratio [95% CI]), 1.19 [1.02, 1.39]) and 11% (1.11 [0.95, 1.31]) greater risk of death respectively, compared to those in the highest fiber intake tertile. No statistically significant associations were observed between dietary fiber intake and adverse cardiovascular and kidney outcomes. Higher dietary fiber intake was not significantly associated with lower levels of C-reactive protein and interleukin-6.
A lower intake of dietary fiber was not associated with all-cause mortality in participants with CKD after adjustments for kidney function and inflammatory biomarkers. There was no significant association between dietary fiber intake and adverse kidney and cardiovascular outcomes. Future randomized intervention trials are needed to identify whether a high dietary fiber intake translates into improved clinical outcomes in CKD.
饮食干预是普通人群预防慢性病的主要手段，但支持此类治疗方法用于慢性肾脏病（CKD）患者的证据尚不充分。本研究的目的是在参与慢性肾功能不全队列研究的CKD患者中，探讨膳食纤维摄入量与不良心血管和肾脏结局以及全因死亡率之间的关联。
共有3791名自我报告了膳食纤维摄入量的慢性肾功能不全队列参与者纳入分析，根据研究基线时膳食纤维三分位数进行分层。使用Cox比例风险模型计算全因死亡率、复合心血管事件和复合肾脏事件发生的风险比，并对人口统计学、临床和实验室特征进行调整，包括炎症标志物、C反应蛋白和白细胞介素-6水平。
每日膳食纤维平均摄入量为15.2克/天。在中位（标准差）随访14.6（4.4）年期间，发生了1074例任何原因导致的死亡。在多变量调整模型中，与膳食纤维摄入量最高三分位的参与者相比，处于中、低膳食纤维三分位的参与者死亡风险分别高19%（风险比[95%置信区间]，1.19[1.02，1.39]）和11%（1.11[0.95，1.31]）。未观察到膳食纤维摄入量与不良心血管和肾脏结局之间存在统计学显著关联。较高的膳食纤维摄入量与较低的C反应蛋白和白细胞介素-6水平无显著关联。
在调整肾功能和炎症生物标志物后，CKD患者膳食纤维摄入量较低与全因死亡率无关。膳食纤维摄入量与不良肾脏和心血管结局之间无显著关联。未来需要进行随机干预试验，以确定高膳食纤维摄入量是否能改善CKD患者的临床结局。
