Abstract
BackgroundA balanced diet is essential to slowing the progression of chronic kidney disease (CKD) and managing the symptoms. Currently, no tool is available to easily and quickly assess energy and macronutrient intake in patients with non end-stage CKD.We aimed to develop and evaluate the validity and reproducibility of a new short 49-item food frequency questionnaire (SFFQ) adapted to patients with CKD.MethodsThe CKD-REIN study is a prospective cohort that enrolled 3033 patients with moderate or advanced CKD from a national sample of nephrology clinics. A sub-sample of 201 patients completed the SFFQ twice, at a one-year interval and were included in the reproducibility study. During this interval, 127 patients also completed six 24-h recalls and were included in the validity study. Main nutrient and dietary intakes were computed. Validity was evaluated by calculating crude, energy-adjusted and de-attenuated correlation coefficients (CC) between FFQ and the mean of the 24-h recall results. Bland-Altman plots were performed and cross-classification into quintiles of consumption of each nutrient and food group was computed. Reproducibility between the two SFFQs was evaluated by intraclass CC (ICC).ResultsRegarding validity, CC ranged from 0.05 to 0.79 (unadjusted CC, median: 0.40) and 0.10 to 0.59 (de-attenuated CC, median: 0.35) for food group and nutrient intakes, respectively. Five of the most important nutrients of interest in CKD, i.e. protein, calcium, phosphorus, potassium, and sodium had de-attenuated CC of 0.46, 0.43, 0.39, 0.32, and 0.12, respectively. The median of classification into the same or adjacent quintiles was 68% and 65% for food and nutrient intakes, respectively, and ranged from 63% to 69% for the five nutrients mentioned before. Bland-Altman plots showed good agreement across the range of intakes. ICC ranged from 0.18 to 0.66 (median: 0.46).ConclusionsThe CKD-REIN SFFQ showed acceptable validity and reproducibility in a sample of patients with CKD, notably for CKD nutrients of importance. It can now be used in large-scale epidemiological studies to easily assess the relations between diet and CKD outcomes as well as in clinical routine. It may also serve as a basis for the development of FFQs in international CKD cohort networks.
Highlights
A balanced diet is essential to slowing the progression of chronic kidney disease (CKD) and managing the symptoms
Between April and June 2014, participants who were included in the CKD-REIN study were informed about the design of the present reproducibility and validity study and were invited to participate
We examined the level of agreement in ranking subjects between the two methods through crossclassification into quintiles, in terms of food group and nutrient intakes
Summary
A balanced diet is essential to slowing the progression of chronic kidney disease (CKD) and managing the symptoms. Chronic Kidney Disease (CKD), defined by the presence of abnormalities in kidney structure or function for a period greater than 3 months, is common [1]. It is associated with high risks of mortality and progression to end-stage renal disease (ESRD), for which kidney replacement therapy (dialysis) or transplantation is required. Epidemiological and clinical evidence have shown links between several micronutrients and CKD [3] In this context, it is currently recommended (but rarely achieved) to reduce dietary protein intake (DPI) to 0.8 g/kg/day from CKD stage 3 [1, 4], even if the DPI effect on the progression of CKD is still debated [5,6,7]. In terms of dietary patterns, the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet, both low in dietary acid load, have been associated with favorable CKD outcomes [3]
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