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Original ArticlesTransplantation
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Mediterranean Style Diet and Kidney Function Loss in Kidney Transplant Recipients

António W. Gomes-Neto, Maryse C.J. Osté, Camilo G. Sotomayor, Else van den Berg, Johanna Marianna Geleijnse, Stefan P. Berger, Reinold O.B. Gans, Stephan J.L. Bakker and Gerjan J. Navis
CJASN February 2020, 15 (2) 238-246; DOI: https://doi.org/10.2215/CJN.06710619
António W. Gomes-Neto
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Maryse C.J. Osté
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Camilo G. Sotomayor
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Else van den Berg
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Johanna Marianna Geleijnse
2Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Stefan P. Berger
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Reinold O.B. Gans
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Stephan J.L. Bakker
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Gerjan J. Navis
1Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Abstract

Background and objectives Despite improvement of short-term graft survival over recent years, long-term graft survival after kidney transplantation has not improved. Studies in the general population suggest the Mediterranean diet benefits kidney function preservation. We investigated whether adherence to the Mediterranean diet is associated with kidney outcomes in kidney transplant recipients.

Design, setting, participants, & measurements We included 632 adult kidney transplant recipients with a functioning graft for ≥1 year. Dietary intake was inquired using a 177-item validated food frequency questionnaire. Adherence to the Mediterranean diet was assessed using a nine-point Mediterranean Diet Score. Primary end point of the study was graft failure and secondary end points included kidney function decline (doubling of serum creatinine or graft failure) and graft loss (graft failure or death with a functioning graft). Cox regression analyses were used to prospectively study the associations of the Mediterranean Diet Score with study end points.

Results During median follow-up of 5.4 (interquartile range, 4.9–6.0) years, 76 participants developed graft failure, 119 developed kidney function decline, and 181 developed graft loss. The Mediterranean Diet Score was inversely associated with all study end points (graft failure: hazard ratio [HR], 0.68; 95% confidence interval [95% CI], 0.50 to 0.91; kidney function decline: HR, 0.68; 95% CI, 0.55 to 0.85; and graft loss: HR, 0.74; 95% CI, 0.63 to 0.88 per two-point increase in Mediterranean Diet Score) independent of potential confounders. We identified 24-hour urinary protein excretion and time since transplantation to be an effect modifier, with stronger inverse associations between the Mediterranean Diet Score and kidney outcomes observed in participants with higher urinary protein excretion and participants transplanted more recently.

Conclusions Adherence to the Mediterranean diet is associated with better kidney function outcomes in kidney transplant recipients.

  • nutrition
  • transplant
  • chronic graft deterioration
  • renal transplantation
  • proteinuria
  • adult
  • graft survival
  • kidney transplantation
  • creatinine
  • Mediterranean diet
  • follow-up studies
  • renal insufficiency
  • kidney
  • death
  • transplants
  • regression analysis
  • surveys and questionnaires
  • humans
  • Received June 9, 2019.
  • Accepted November 22, 2019.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (2)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 2
February 07, 2020
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Mediterranean Style Diet and Kidney Function Loss in Kidney Transplant Recipients
António W. Gomes-Neto, Maryse C.J. Osté, Camilo G. Sotomayor, Else van den Berg, Johanna Marianna Geleijnse, Stefan P. Berger, Reinold O.B. Gans, Stephan J.L. Bakker, Gerjan J. Navis
CJASN Feb 2020, 15 (2) 238-246; DOI: 10.2215/CJN.06710619

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Mediterranean Style Diet and Kidney Function Loss in Kidney Transplant Recipients
António W. Gomes-Neto, Maryse C.J. Osté, Camilo G. Sotomayor, Else van den Berg, Johanna Marianna Geleijnse, Stefan P. Berger, Reinold O.B. Gans, Stephan J.L. Bakker, Gerjan J. Navis
CJASN Feb 2020, 15 (2) 238-246; DOI: 10.2215/CJN.06710619
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Keywords

  • nutrition
  • transplant
  • chronic graft deterioration
  • renal transplantation
  • proteinuria
  • adult
  • graft survival
  • kidney transplantation
  • creatinine
  • Mediterranean diet
  • Follow-Up Studies
  • renal insufficiency
  • kidney
  • Death
  • Transplants
  • regression analysis
  • surveys and questionnaires
  • Humans

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