The associations of plant-based protein intake with all-cause and cardiovascular mortality in patients on peritoneal dialysis |
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| Institution: | 1. Department of Nephrology, Qilu Hospital of Shandong University, Jinan, China;2. Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health and Key Laboratory of Renal Disease, Ministry of Education, Beijing, China;3. Department of Nephrology, Linyi People''s Hospital, Linyi, China;1. Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói-RJ, Brazil;2. Medical Sciences Graduate Program, Federal University Fluminense (UFF), Niterói-RJ, Brazil;3. Institute of Microbiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil;4. Basic Pathology Department, Federal University of Paraná (UFPR), Curitiba-PR, Brazil;5. Faculty of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil;7. Department of Nephrology, Centre Hospitalier Lyon Sud, Univ Lyon, UCBL, Inserm Carmen, CENS, F-69622 Lyon, France;1. Dialysis Clinic, Inc., Lexington, Kentucky;2. Life Works Integrated Therapeutic Solutions, Lexington, Kentucky;1. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN;2. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;3. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN;4. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN;5. Department of Pharmacy, Mayo Clinic, Rochester, MN;6. Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN;1. Department of Internal Medicine-Nephrology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;2. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;3. Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand;4. Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Banphaeo, Thailand;5. Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;1. Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Division of Nephrology and Hypertension, University of California, Irvine, School of Medicine, Orange, California;1. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD;2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;3. Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA;4. Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD;5. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA;6. Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA;7. Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA;8. Division of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, OH;9. Division of Nephrology, Baylor College of Medicine, Houston, TX;10. Department of Medicine, University of Illinois, Chicago, IL;11. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;12. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;13. Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;14. Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD |
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| Abstract: | Background and aimsPlant-based protein intake is associated with all-cause and/or cardiovascular disease (CVD) mortality in general population, but such data are scarce in dialysis patients. Thus, we examined the associations of plant-based protein–total protein ratio with all-cause and CVD mortality in patients on peritoneal dialysis (PD).Methods and resultsThe study enrolled 884 incident patients who started PD between October 2002 and August 2014. All demographic and laboratory data were recorded at baseline. Repeated measurements for laboratory and nutrition parameters were recorded at regular intervals and thus calculated as time-averaged values. Multivariable Cox regression models were used to estimate the hazard ratio (HR) of plant-based protein–total protein ratio and mortality based on baseline and time-averaged covariates, respectively. There were 437 (49%) patients died during a mean follow-up period of 45 months, of which 178 (40.8%) were due to CVD. Each 10% in increase in time-averaged plant-based protein–total protein ratio was associated with a reduction of 71% (95% CI, 90%–14%) and 89% (95% CI, 98%–29%) for all-cause and CVD mortality, respectively. Based on examination on interactive effects, we further found both baseline and time-averaged plant-based protein–total protein ratio were inversely associated with all-cause and CVD mortality in the subgroups of female, age ≥60 years, and albumin >35 g/L.ConclusionsThe present study suggested that a diet with a higher plant-based protein–total protein ratio is associated with lower all-cause and CVD mortality in PD patients, and is more significant in female and elderly patients, and those without hypoalbuminemia. |
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| Keywords: | Peritoneal dialysis Plant-based protein Animal-based protein CVD Mortality |
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