Relative energy balance, chronic kidney disease and risk of cardiovascular and all-cause mortality

Aim: To determine the association between the relative energy intake, and the risk of all-cause and cardiovascular mortality in people with early to moderate stage CKD. Background: Obesity and excess energy intake relative to output are risk factors for cardiovascular and all-cause mortality in the general population. However, previous studies have reported an inverse relationship between obesity and mortality risk among those on dialysis. The association between relative energy intake and mortality risk among those with mild-moderately reduced kidney function is unclear. Methods: Analysis included 1245 men and 1490 women aged ≥49 years at baseline from a population-based cohort in the Blue Mountains, Sydney, Australia. We assessed the relationship between relative energy balance and the risk of all-cause and cardiovascular mortality in people with and without reduced kidney function using unadjusted and adjusted Cox proportional regression models. Results: There is an increased risk of all-cause (adjusted HR 1.48, 95% CI 1.05 to 2.09, p = 0.026) and cardiovascular mortality (adjusted HR 1.64, 95% CI 0.94 to 2.84, p = 0.078) among those with higher relative energy intake compared with those with lower relative energy intake in the CKD population. Simple sugar (per 100 g, HR: 1.33, 95% CI: 1.08 to 1.64, p = 0.007) was signifi cantly associated with an increased risk of all-cause mortality. Conclusions: Relative energy intake, but not BMI, is a signifi cant risk factor for all-cause and cardiovascular mortality among elderly people with CKD. Doubling the relative energy intake is associated with a 48% increased risk for all-cause and 63% vascular mortality among those with early to moderate stage CKD, irrespective of their body mass index. Strategies to limit the energy and sugar intake may reduce the burden of premature deaths.