DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease

Casey M. Rebholz, Deidra C. Crews, Morgan E. Grams, Lyn M. Steffen, Andrew S. Levey, Edgar R. Miller, Lawrence J. Appel, Josef Coresh

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Background There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention. Evidence is lacking for effective dietary patterns for kidney disease prevention. Study Design Prospective cohort study. Setting & Participants Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (N = 14,882). Predictor The Dietary Approaches to Stop Hypertension (DASH) diet score was calculated based on self-reported dietary intake of red and processed meat, sweetened beverages, sodium, fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy products, averaged over 2 visits. Outcomes Cases were ascertained based on the development of eGFRs < 60 mL/min/1.73 m2 accompanied by ≥25% eGFR decline from baseline, an International Classification of Diseases, Ninth/Tenth Revision code for a kidney disease−related hospitalization or death, or end-stage renal disease from baseline through 2012. Results 3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile (HR, 1.16; 95% CI, 1.07-1.26; P for trend < 0.001), after adjusting for sociodemographics, smoking status, physical activity, total caloric intake, baseline eGFR, overweight/obese status, diabetes status, hypertension status, systolic blood pressure, and antihypertensive medication use. Of the individual components of the DASH diet score, high red and processed meat intake was adversely associated with kidney disease and high nuts, legumes, and low-fat dairy products intake was associated with reduced risk for kidney disease. Limitations Potential measurement error due to self-reported dietary intake and lack of data for albuminuria. Conclusions Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics, established kidney risk factors, and baseline kidney function. Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention.

Original languageEnglish (US)
Pages (from-to)853-861
Number of pages9
JournalAmerican Journal of Kidney Diseases
Issue number6
StatePublished - Dec 1 2016

Bibliographical note

Funding Information:
Support: The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts ( HHSN268201100005C , HHSN268201100006C , HHSN268201100007C , HHSN268201100008C , HHSN268201100009C , HHSN268201100010C , HHSN268201100011C , and HHSN268201100012C ). Drs Crews and Grams are supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases ( K23 DK097184 and K08 DK092287 , respectively). The funders did not have a role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.


  • Chronic kidney disease (CKD)
  • DASH diet score
  • diet
  • dietary acid load
  • dietary protein
  • disease progression
  • food frequency questionnaire
  • health promotion
  • incident kidney disease
  • kidney disease prevention
  • modifiable risk factor
  • renal function

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