Lowering sugar and carbohydrates reduces mortality risk in patients with CKD

The researchers suggest, "dietary advice should be given according to the current diet structure (particularly the percentage of carb intake), and non-sugar/sugar carbohydrates should be considered when adjusting the carbohydrate intake in CKD patient."

Diet management is an effective way to slow the progression of chronic kidney disease. However, not many studies have determined the impact of carbohydrate intake on CKD patients. Qidong Ren, Department of Nephrology, Peking Union Medical College Hospital, Beijing, P.R. China, and colleagues investigated the associations between carbohydrate intake and all-cause mortality in U.S. adult CKD patients by conducting a prospective cohort study using data from the NHANES (National Health and Nutrition Examination Survey).

"Unlike many previous studies that only focused on single macronutrients and linear associations with outcomes, we determined the non-linear associations of macronutrients and their constituents," the authors wrote.

The iso-caloric replacement analysis and Multivariable Cox proportional hazard models determined the associations between the macronutrients and the all-cause mortality risk. A study was conducted of 3683 US adult CKD patients 20 years or older (mean age 62.4 years; 56.5% female) from the NHANES. From 3683 CKD patients, 1082 participants with CKD died with a median follow-up time of 67 months.

The study led to the following findings:

• Most macronutrients, including carbohydrates and sugar, were non-linearly associated with all-cause mortality risk.
• Participants with CKD had lower mortality risk when consuming 30–45% energy from carbohydrates (average HR 0.76, compared with 60%) and 5–20% energy from sugar (average HR 0.75, compared with 40%).
• Replacing the energy intake from carbohydrates with protein (up to 30%) and replacing sugar with non-sugar carbohydrates (up to 55%) reduced the all-cause mortality risk. In contrast, the total energy intake remained constant.

The findings showed non-linear associations between the macronutrients and all-cause mortality risk in patients with chronic kidney disease. Low carbohydrate intake reduced the all-cause mortality risk. Additionally, the different effects of the carbohydrate constituents on all-cause mortality risk were observed.

"Non-sugar carbohydrates reduced the mortality risk while sugar raised the mortality risk," the researchers wrote. They found a higher mortality risk with the increase in carbohydrate intake, and further investigation showed higher sugar intake was tied with a higher mortality risk.

They further suggested that "replacing carbohydrates with protein (including plant and animal protein), plant fat and polyunsaturated fat lowered the mortality risk."

Reference:

Ren Q, Zhou Y, Luo H, Chen G, Han Y, Zheng K, Qin Y, Li X. Associations of low-carbohydrate with mortality in chronic kidney disease. Ren Fail. 2023 Dec;45(1):2202284. doi: 10.1080/0886022X.2023.2202284. PMID: 37271873; PMCID: PMC10243376.