Dietary patterns and risk of incident chronic kidney disease: The Atherosclerosis Risk in Communities study

Emily A. Hu, Lyn M. Steffen, Morgan E. Grams, Deidra C. Crews, Josef Coresh, Lawrence J. Appel, Casey M. Rebholz

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


BACKGROUND: Adherence to healthy dietary patterns, measured by the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), and alternate Mediterranean diet (aMed) scores, is associated with a reduced risk of cardiovascular disease. The association between these scores and chronic kidney disease (CKD) is undetermined.

OBJECTIVE: We aimed to estimate the association between the HEI, AHEI, and aMed scores and risk of incident CKD.

METHODS: We conducted a prospective analysis in 12,155 participants aged 45-64 y from the Atherosclerosis Risk in Communities (ARIC) Study. We calculated HEI-2015, AHEI-2010, and aMed scores for each participant and categorized them into quintiles of each dietary score. Incident CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 accompanied by ≥25% decline in estimated glomerular filtration rate, a kidney disease-related hospitalization or death, or end-stage renal disease. We used cause-specific hazard models to estimate risk of CKD from the quintile of the dietary score through to 31 December 2017.

RESULTS: There were 3980 cases of incident CKD over a median follow-up of 24 y. Participants who had higher adherence to the HEI-2015, AHEI-2010, and aMed scores were more likely to be female, have higher educational attainment, higher income level, be nonsmokers, more physically active, and diabetic compared with participants who scored lower. All 3 dietary scores were associated with lower CKD risk (P-trend < 0.001). Participants who were in the highest quintile of HEI-2015 score had a 17% lower risk of CKD (HR: 0.83; 95% CI: 0.74, 0.92) compared with participants in the lowest quintile. Those in quintile 5 of AHEI-2010 and aMed scores, respectively, had a 20% and 13% lower risk of CKD compared with those in quintile 1.

CONCLUSION: Higher adherence to healthy dietary patterns during middle age was associated with lower risk of CKD.

Original languageEnglish (US)
Pages (from-to)713-721
Number of pages9
JournalAmerican Journal of Clinical Nutrition
Issue number3
StatePublished - Sep 1 2019

Bibliographical note

Publisher Copyright:
Copyright © American Society for Nutrition 2019.


  • AHEI
  • ARIC
  • DASH
  • HEI
  • Mediterranean
  • dietary patterns
  • dietary scores
  • kidney disease
  • renal disease

PubMed: MeSH publication types

  • Journal Article


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