Associations of Dietary Index Adherence with The Progression of Chronic Kidney Disease Across Cardio-metabolic disorders: Findings from Multi-state Models of a Nationwide Cohort Study.

Objective: The associations of dietary guidelines with the progression from a healthy state to cardio-metabolic disorders, then to chronic kidney disease (CKD), and ultimately to death remain unclear. This study aimed to evaluate the associations of multiple dietary pattern indices with CKD progression originating from cardio-metabolic disorders.

Methods: Using data from 205,826 participants in the UK Biobank, we applied multi-state models to trace CKD trajectories. Nine dietary pattern indexes were derived from 24-hour dietary recalls, and their associations with the risk of transitioning to CKD from cardio-metabolic, as well as subsequent mortality, were evaluated using Cox regression.

Results: Greater adherence to the AHA dietary pattern was significantly associated with the lowest risk of developing CKD (HR for Q5 vs. Q1 = 0.63, 95% CI: 0.55-0.71). In comparison, adherence to other dietary patterns such as the DRRD and EAT-Lancet diets conferred weaker protective associations. Conversely, the high adherence to an unhealthful PDI was linked to an elevated CKD risk (HR = 1.44, 95% CI: 1.26-1.64, Q5 vs. Q1). Multi-state model analyses revealed that each 1-unit increase in the AHA diet Z-score was associated with a reduced risk of CKD following cardio-metabolic conditions (HR = 0.89, 95% CI: 0.81-0.97), with a more pronounced risk reduction among participants with T2DM (HR = 0.83, 95% CI: 0.71-0.97). However, no significant association was found between dietary indices adherence and mortality after CKD onset.

Conclusion: The AHA diet demonstrated superior protection against CKD incidence and progression from cardio-metabolic disorders, highlighting its clinical priority for early intervention. No dietary pattern influenced mortality after CKD onset, emphasizing the need for tailored prevention strategies in high-risk populations.