Poor accordance to a DASH dietary pattern is associated with higher risk of ESRD among adults with moderate chronic kidney disease and hypertension

Tanushree Banerjee, Deidra C. Crews, Delphine S. Tuot, Meda E. Pavkov, Nilka Rios Burrows, Austin G. Stack, Rajiv Saran, Jennifer Bragg-Gresham, Neil R. Powe, Neil R. Powe, Delphine Tuot, Chi yuan Hsu, Charles McCulloch, Deidra Crews, Raymond Hsu, Vanessa Grubbs, Kirsten Bibbins-Domingo, Michael Shlipak, Carmen Peralta, Anna RubinskyJosef Coresh, Vahakn Shahinian, Brenda Gillespie, Hal Morgenstern, Michael Heung, William Herman, William McClellan, Diane Steffick, Anca Tilea, Maggie Yin, Ian Robinson, Kara Zivin, Vivian Kurtz, April Wyncott, Nilka Ríos Burrows, Mark Eberhardt, Linda Geiss, Juanita Mondesire, Bernice Moore, Priti Patel, Meda Pavkov, Deborah Rolka, Sharon Saydah, Sundar Shrestha, Larry Waller

Research output: Contribution to journalArticlepeer-review


The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure, an important risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, it is unclear whether adherence to a DASH diet confers protection against future ESRD, especially among those with pre-existing CKD and hypertension. We examined whether a DASH diet is associated with lower risk of ESRD among 1,110 adults aged ≥ 20 years with hypertension and CKD (estimated glomerular filtration rate, eGFR 30-59 ml/min/1.73 m2) enrolled in the National Health and Nutrition Examination Survey (1988-1994). Baseline DASH diet accordance score was assessed using a 24-hour dietary recall questionnaire. ESRD was ascertained by linkage to the U.S. Renal Data System registry. We used the Fine-Gray competing risks method to estimate the relative hazard (RH) for ESRD after adjusting for sociodemographics, clinical and nutritional factors, eGFR, and albuminuria. Over a median follow-up of 7.8 years, 18.4% of subjects developed ESRD. Compared to the highest quintile of DASH diet accordance, there was a greater risk of ESRD among subjects in quintiles 1 (RH=1.7; 95% CI 1.1-2.7) and 2 (RH 2.2; 95% CI 1.1-4.1). Significant interactions were observed with diabetes status and race/ethnicity, with the strongest association between DASH diet adherence and ESRD risk observed in individuals with diabetes and in non-Hispanic blacks. Low accordance to a DASH diet is associated with greater risk of ESRD in adults with moderate CKD and hypertension, particularly in non-Hispanic blacks and persons with diabetes.

Original languageEnglish (US)
Pages (from-to)1433-1442
Number of pages10
JournalKidney international
Issue number6
StatePublished - Jun 2019


  • CKD
  • ESRD
  • diabetes
  • diet

ASJC Scopus subject areas

  • Nephrology

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