Diet and Kidney Disease in High-Risk Individuals With Type 2 Diabetes Mellitus

Study Questions:

What is the influence of dietary factors on the incidence or progression of chronic kidney disease (CKD) among individuals with type 2 diabetes mellitus?


This was an observational study of 6,213 individuals with type 2 diabetes without macroalbuminuria enrolled in ONTARGET (Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial). Diet quality was assessed using the modified Alternate Healthy Eating Index (mAHEI); alcohol intake was measured by the number of drinks per week. Main study outcomes were incidence or progression of CKD and mortality.


After 5.5 years of follow-up, 1,971 participants (31.7%) experienced the combined renal endpoint of incidence or progression of CKD, and 516 participants (8.3%) died. Compared with participants in the least healthy tertile of mAHEI score, participants in the healthiest tertile had a lower risk of CKD (adjusted odds ratio [OR], 0.74; 95% confidence interval [CI], 0.64-0.84) and lower risk of mortality (OR, 0.61; 95% CI, 0.48-0.78). Compared to those in the highest tertile of total and animal protein intake, those in the lowest tertile had an increased risk of CKD (OR, 1.16; 95% CI, 1.05-1.30). Urinary sodium excretion was not associated with CKD, and moderate alcohol intake reduced the risk of CKD. However, the association between mortality and sodium intake was U-shaped (with increased mortality observed at estimated sodium excretions <3 g/day and more than 7 g/day).


In patients with type 2 diabetes mellitus, a healthy diet (rich in fruits and vegetables) and moderate alcohol consumption may decrease the incidence or progression of CKD.


The minor limitations of this observational study aside, the current analysis provides guidance on dietary factors that may reduce risk of developing CKD or slow progression of early kidney disease in type 2 diabetics. Based on the results of this analysis, providers should continue to advocate a healthy diet for these patients, emphasizing the benefits of fruits and vegetables. Interestingly, neither low protein intake nor low sodium intake reduced the incidence or progression of CKD. These observations are counter to current nutritional recommendations. As suggested by the authors, it will be prudent to counsel patients to avoid extremes of protein and salt intake.

Clinical Topics: Prevention, Diet

Keywords: Fruit, Kidney Diseases, Vegetables, Diet, Diabetes Mellitus

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