Diet soda consumption and risk of incident end stage renal disease

Casey M. Rebholz, Morgan E. Grams, Lyn M. Steffen, Deidra C. Crews, Cheryl A.M. Anderson, Lydia A. Bazzano, Josef Coresh, Lawrence J. Appel

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background and objectives Diet soda consumption is common in the United States and is associated with impaired glucose metabolism, diabetes, and metabolic syndrome. Design, setting, participants, & measurements We prospectively analyzed diet soda consumption, assessed by food frequency questionnaire at baseline (1987–1989) and a follow-up examination (1993–1995), and incident ESRD through December 31, 2012 in the Atherosclerosis Risk in Communities study (n=15,368). Results Baseline mean age of participants was 54 years, 55% were female, and 27% were black. The majority of participants (43.5%) consumed <1 glass/wk of diet soda; 17.8% consumed 1–4 glasses/wk; 25.3% consumed 5–7 glasses/wk; and 13.5% consumed >7 glasses/wk. Over a median follow-up of 23 years, 357 incident ESRD cases were observed. Relative to <1 glass/wk of diet soda, consuming 1–4 glasses/wk, 5–7 glasses/wk, and >7 glasses/wk, respectively, was associated with 1.08-times (95% confidence interval [95% CI], 0.75 to 1.55), 1.33-times (95% CI, 1.01 to 1.75), and 1.83-times (95% CI, 1.01 to 2.52) higher risk of ESRD after adjusting for age, sex, race-center, education level, smoking status, physical activity, total caloric intake, eGFR, body mass index category, diabetes, systolic BP, and serum uric acid (P value for trend <0.001). Results were similar after additional adjustment for dietary acid load, diet quality, dietary sodium, dietary fructose, sugar-sweetened beverages, and dietary phosphorus. Risk estimates were similar by body mass index category (P value for interaction = 0.82), but the association between diet soda and ESRD was only significant for those who were overweight or obese at baseline. Sugar-sweetened beverage consumption was not significantly associated with ESRD in the fully adjusted model. Conclusions Diet soda consumption was associated with higher ESRD risk in this general population sample. Further research is necessary to validate these findings in other study populations and to examine potential mechanisms through which diet soda could impact kidney disease.

Original languageEnglish (US)
Pages (from-to)79-86
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Issue number1
StatePublished - Jan 6 2017

Bibliographical note

Funding Information:
The authors thank the staff and participants of the Atherosclerosis Risk in Communities (ARIC) study for their important contributions. The ARIC study is carried outasa collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN26820110001OC, HHSN268201100011C, and HHSN268201100012C). C.M.R. is supported by grant K01 DK107782, M.E.G. is supported by grant K08 DK092287, and D.C.C. is supported by grant K23 DK097184, all from the National Institute of Diabetes and Digestive and Kidney Diseases. Parts of this study were presented in abstract form at the American Heart Association Epidemiology and Prevention/Lifestyle and Cardiometabolic Health Scientific Sessions held March 1–4, 2016 in Phoenix, Arizona. Some of the data reported here have been supplied by the US Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the United States government.

Publisher Copyright:
© 2016 by the American Society of Nephrology.


  • Atherosclerosis
  • Beverages
  • Blood pressure
  • Body mass index
  • Diabetes, mellitus
  • Diet
  • Energy intake
  • Female
  • Follow-up studies
  • Fructose
  • Glomerular filtration rate
  • Glucose
  • Kidney failure, chronic
  • Metabolic syndrome X
  • Motor activity
  • Obesity
  • Overweight
  • Phosphorus, dietary
  • Smoking
  • Sodium, dietary
  • Surveys and questionnaires
  • Sweetening agents
  • United States
  • Uric acid


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