Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study

Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with...

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Veröffentlicht in:American journal of kidney diseases 2021-11, Vol.78 (5), p.649-657.e1
Hauptverfasser: He, Yanhuan, Lu, Yongxin, Yang, Shenglin, Li, Yumin, Yang, Yaya, Chen, Junzhi, Huang, Yan, Lin, Zizhen, Li, Youbao, Kong, Yaozhong, Zhao, Yanhong, Wan, Qijun, Wang, Qi, Huang, Sheng, Liu, Yan, Liu, Aiqun, Liu, Fanna, Hou, Fan Fan, Qin, Xianhui, Liang, Min
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container_issue 5
container_start_page 649
container_title American journal of kidney diseases
container_volume 78
creator He, Yanhuan
Lu, Yongxin
Yang, Shenglin
Li, Yumin
Yang, Yaya
Chen, Junzhi
Huang, Yan
Lin, Zizhen
Li, Youbao
Kong, Yaozhong
Zhao, Yanhong
Wan, Qijun
Wang, Qi
Huang, Sheng
Liu, Yan
Liu, Aiqun
Liu, Fanna
Hou, Fan Fan
Qin, Xianhui
Liang, Min
description Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations. Prospective observational cohort study. 1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015. The proportion of plant protein intake to total protein intake. All-cause mortality and cardiovascular disease (CVD) mortality. Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes. The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion
doi_str_mv 10.1053/j.ajkd.2021.03.023
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We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations. Prospective observational cohort study. 1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015. The proportion of plant protein intake to total protein intake. All-cause mortality and cardiovascular disease (CVD) mortality. Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes. The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion&lt;45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%. Observational study, potential unmeasured confounding. There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population. 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We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations. Prospective observational cohort study. 1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015. The proportion of plant protein intake to total protein intake. All-cause mortality and cardiovascular disease (CVD) mortality. Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes. The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. 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If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population. 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We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations. Prospective observational cohort study. 1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015. The proportion of plant protein intake to total protein intake. All-cause mortality and cardiovascular disease (CVD) mortality. Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes. The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion&lt;45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%. Observational study, potential unmeasured confounding. There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population. [Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34052356</pmid><doi>10.1053/j.ajkd.2021.03.023</doi></addata></record>
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subjects Adult
All-cause mortality
cardiovascular disease (CVD)
Cardiovascular Diseases
Cohort Studies
cohort study
CVD mortality
diet
dietary protein
end-stage renal disease (ESRD)
Humans
maintenance hemodialysis (MHD)
Middle Aged
modifiable risk factor
Mortality
nutrition
plant protein intake proportion
Plant Proteins, Dietary
Proportional Hazards Models
Prospective Studies
Renal Dialysis
Risk Factors
soy
title Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study
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