Abstract

Lifestyle and dietary habits influence kidney function, playing an important role in the prevention and development of chronic kidney disease (CKD). The effectiveness of the Mediterranean diet in preserving kidney function has been seen in primary prevention. However, no scientific evidence is currently available to determine which dietary pattern is more effective in the management of CKD in secondary cardiovascular disease prevention. Thus, our aim was to evaluate the efficacy of the long-term consumption of two healthy dietary patterns (a Mediterranean diet rich in extra-virgin olive oil (EVOO) compared to a low-fat diet rich in complex carbohydrates) in preserving kidney function in coronary heart disease (CHD) patients. CHD patients (n=1002) from the CORDIOPREV study were randomized to follow a Mediterranean diet (35% fat, 22% MUFA, <50% carbohydrates) or a low-fat diet (28% fat, 12% MUFA, >55% carbohydrates). Kidney function was assessed by the determination of serum creatinine-based estimated glomerular filtration rate (eGFR) at baseline and after 5-years of dietary intervention. Patients were classified according to their type 2 diabetes (T2DM) status, using baseline eGFR (normal eGFR: ≥ 90mL/min/1.73m2; mildly-impaired eGFR: 60 to <90mL/min/1.73m2, severely-impaired eGFR: <60mL/min/1.73m2) to evaluate its influence on the progression of kidney function. Multiple linear regression analysis were performed to determine the contribution of different clinical and anthropometric parameters to changes in eGFR. Although eGFR declined after both dietary interventions compared to baseline (all p<0.001), the Mediterranean diet produced a lower decline of eGFR compared to the low-fat diet in patients with T2DM (p=0.040). This effect was also observed when the overall population was considered (p=0.033). No significant differences were observed in eGFR between the two diets in non-T2DM patients. In addition, this differential effect of the Mediterranean diet was mainly observed in patients with mildly-impaired eGFR in which this diet slowed eGFR progression (p=0.002). The long-term consumption of a Mediterranean diet rich in EVOO, when compared to a low-fat diet, may preserve kidney function, as shown by a reduced decline in eGFR in CHD patients with T2DM. Patients with mildly-impaired eGFR may benefit more from the beneficial effect of the consumption of the Mediterranean diet in preserving kidney function. These findings reinforce the clinical benefits of the Mediterranean diet in the context of secondary cardiovascular disease prevention. URL, http://www.cordioprev.es/index.php/en. Clinicaltrials.gov number, NCT00924937.

Highlights

  • Considering all the above, in this secondary prevention study, we evaluate the efficacy of the long-term consumption of two healthy dietary patterns in delaying the impairment of kidney function in coronary heart disease (CHD) patients with and without T2DM

  • Kidney function was evaluated by determining the serum creatinine-based estimated glomerular filtration rate, calculated using the Chronic kidney disease (CKD)-Epi (CKD Epidemiology Collaboration) equation (4) [49] as follows: for women, for sCr level 62 mmol/L), eGFR 1⁄4 144 Â À1.209 Â (0.993 age)

  • In order to analyze the influence of eGFR at baseline on the evolution of kidney function during the 5-years of dietary intervention, we classified the population into three categories according to eGFR at baseline: a) normal eGFR (!90 mL/min/1.73 m2, n 1⁄4 514), b) mildly-impaired eGFR (60 to

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Summary

Introduction

Chronic kidney disease (CKD) is a global health problem that affects more than 10% of the general adult population, imposing a significant economic burden on both the health-care system and society [1,2]. Our aim was to evaluate the efficacy of the long-term consumption of two healthy dietary patterns (a Mediterranean diet rich in extra-virgin olive oil (EVOO) compared to a low-fat diet rich in complex carbohydrates) in preserving kidney function in coronary heart disease (CHD) patients. Results: eGFR declined after both dietary interventions compared to baseline (all p < 0.001), the Mediterranean diet produced a lower decline of eGFR compared to the low-fat diet in patients with T2DM (p 1⁄4 0.040). This effect was observed when the overall population was considered (p 1⁄4 0.033).

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