Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Maryse C J Osté, António W Gomes-Neto, Eva Corpeleijn, Rijk O B Gans, Martin H de Borst, Else van den Berg, Sabita S Soedamah-Muthu, Daan Kromhout, Gerjan J Navis, Stephan J L Bakker, Maryse C J Osté, António W Gomes-Neto, Eva Corpeleijn, Rijk O B Gans, Martin H de Borst, Else van den Berg, Sabita S Soedamah-Muthu, Daan Kromhout, Gerjan J Navis, Stephan J L Bakker

Abstract

Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177-item food frequency questionnaire and an overall DASH-score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow-up of 5.3 (interquartile range, 4.1-6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death-censored graft failure, and 128 (20.3%) died. In Cox-regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33-0.96, P = .03) and all-cause mortality (HR = 0.52; 95%CI, 0.32-0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH-style diet is associated with lower risk of both renal function decline and all-cause mortality. These results suggest that a healthful diet might benefit long-term outcome in RTR.

Trial registration: ClinicalTrials.gov NCT02811835.

Keywords: clinical research/practice; graft survival; kidney transplantation/nephrology; nutrition; patient survival.

© 2018 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1
Figure 1
Frequency distribution of the Dietary Approach to Stop Hypertension (DASH) score in the overall renal transplant recipients population (632 participants)
Figure 2
Figure 2
Association between the Dietary Approach to Stop Hypertension (DASH) score on renal function decline and all‐cause mortality in 632 renal transplant recipients. Data were fit by a Cox regression model based on penalized splines and adjusted for age and sex. The gray area represents the 95% confidence interval
Figure 3
Figure 3
Stratified analyses of the association of the DASH score on renal function decline in RTR adjusted for age and sex. Subgroups with P < .05 were considered effect modifiers. BMI, body mass index; DASH, Dietary Approach to Stop Hypertension; eGFR, estimated glomerular filtration rate; RTR, renal transplant recipients; SBP, systolic blood pressure; SQUASH, Short QUestionnaire to ASsess Health enhancing physical activity
Figure 4
Figure 4
Stratified analyses of the association of the DASH score on all‐cause mortality in RTR adjusted for age and sex. Subgroups with P < .05 were considered effect modifiers. BMI, body mass index; DASH, Dietary Approach to Stop Hypertension; eGFR, estimated glomerular filtration rate; RTR, renal transplant recipients; SBP, systolic blood pressure; SQUASH, Short QUestionnaire to ASsess Health enhancing physical activity

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