Dietary Fiber Intake and Clinical Outcomes in Chronic Kidney Disease: A Report from the Chronic Renal Insufficiency Cohort (CRIC) study

Abstract

ObjectiveDietary 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 (CRIC) study. Design and MethodsA total of 3791 CRIC 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 (CRP) and Interleukin-6 (IL-6). ResultsMean daily dietary fiber intake was 15.2 g/d. During a median (SD) 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% (HR [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 statistical 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 CRP and IL-6. ConclusionA 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.