Impact of Kidney Function on Effects of the Dietary Approaches to Stop Hypertension (Dash) Diet

Crystal C Tyson, Maragatha Kuchibhatla, Uptal D Patel, Patrick H Pun, Alex Chang, Chinazo Nwankwo, Michael A Joseph, Laura P Svetkey, Crystal C Tyson, Maragatha Kuchibhatla, Uptal D Patel, Patrick H Pun, Alex Chang, Chinazo Nwankwo, Michael A Joseph, Laura P Svetkey

Abstract

Objectives: Although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure in adults with hypertension, how kidney function impacts this effect is not known. We evaluated whether Estimated Glomerular Filtration Rate (eGFR) modifies the effect of the DASH diet on blood pressure, markers of mineral metabolism, and markers of kidney function.

Methods: Secondary analysis of the DASH-Sodium trial, a multicenter, randomized, controlled human feeding study that evaluated the blood pressure lowering effect of the DASH diet at three levels of sodium intake. Data from 92 participants with pre-hypertension or stage 1 hypertension during the 3450 mg /day sodium diet assignment contributed to this analysis. Stored frozen plasma and urine specimens were used to measure kidney related laboratory outcomes.

Results: Effects of the DASH diet on blood pressure, phosphorus, intact parathyroid hormone, creatinine, and albuminuria were not modified by baseline eGFR (mean 84.5 ± 18.0 ml/min/1.73 m2, range 44.1 to 138.6 ml/min/1.73 m2) or the presence of chronic kidney disease (N=13%).

Conclusions: The impact of the DASH diet on blood pressure, markers of mineral metabolism, and markers of kidney function does not appear to be modified by eGFR in this small subset of DASH-Sodium trial participants with relatively preserved kidney function. Whether greater reduction in eGFR modifies the effects of DASH on kidney related measures is yet to be determined. A larger study in individuals with more advanced kidney disease is needed to establish the efficacy and safety of the DASH diet in this patient population.

Keywords: Blood pressure; Diet; Hypertension; Kidney disease.

Figures

Figure 1
Figure 1
Change in blood pressure for 89 participants of the DASH-Sodium trial by diet assignment after a 4-week feeding intervention. General linear models were adjusted for site, intervention period, baseline blood pressure, estimated glomerular filtration rate, race, gender, age and body mass index. Between group difference (DASH minus Control) and p-values are offset in boxes. *p=0.02. Sample size is 42 for control and 47 for DASH (minus 3 participants with missing pre- or post-intervention BP). SBP, systolic blood pressure; DBP, diastolic blood pressure; CI, 95% confidence interval; diff, difference.
Figure 2
Figure 2
Change in measures of mineral metabolism for participants of the DASH-Sodium trial by diet assignment after a 4-week feeding intervention. General linear models were adjusted for site, intervention period, baseline estimated glomerular filtration rate, and each respective baseline value (phosphorus, iPTH). Between group difference (DASH minus Control) and p-values are offset in boxes. *statistically significant. Sample size for phosphorus was 83 (38 control and 45 DASH minus 9 participants with missing pre- or post-intervention data) and iPTH was 80 (39 control and 41 DASH minus 12 participants with missing pre- or post-intervention data). iPTH, intact parathyroid hormone; CI, 95% confidence interval; diff, difference.
Figure 3
Figure 3
Change in kidney function for 92 participants of the DASH-Sodium trial by diet assignment after a 4-week feeding intervention. General linear models were adjusted for site, intervention period, baseline eGFR, and each respective baseline value (creatinine, eGFR, UACR). Between group difference (DASH minus Control) and p-values for participants with both preand post-intervention plasma or urine samples are offset in boxes. Sample sizes for creatinine, eGFR and UACR were 81 (control 38, DASH 43), 87 (42 control, 45 DASH), and 72 (34 control, 38 DASH), respectively. eGFR, estimated glomerular filtration rate; UACR, urine albumin-to-creatinine ratio; CI, 95% confidence interval; diff, difference.

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