• Xiaorui Chen, Guo Wei, Thunder Jalili, Julie Metos, Ajay Giri, Monique E Cho, Robert Boucher, Tom Greene, and Srinivasan Beddhu.
• Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; Division of Nutrition, University of Utah, Salt Lake City, UT.
• Am. J. Kidney Dis. 2016 Mar 1; 67 (3): 423-30.

BackgroundPlant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease.Study DesignObservational study.Settings & Participants14,866 NHANES III participants 20 years or older without missing data for plant and animal protein intake and mortality.PredictorsPlant protein to total protein ratio and total plant protein intake. Patients were stratified by estimated glomerular filtration rate (eGFR)<60 or ≥60mL/min/1.73m(2).OutcomesAll-cause mortality.MeasurementsPlant and total protein intakes were estimated from 24-hour dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through December 31, 2000.ResultsMean values for plant protein intake and plant protein to total protein ratio were 24.6±13.2 (SD) g/d and 33.0% ± 14.0%, respectively. The prevalence of eGFRs<60mL/min/1.73m(2) was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbid conditions, body mass index, calorie and total protein intake, and physical inactivity, each 33% increase in plant protein to total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR≥60mL/min/1.73m(2) subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR<60mL/min/1.73m(2) subpopulation. In sensitivity analyses, results were similar in those with eGFR<60mL/min/1.73m(2) defined by serum cystatin C level.LimitationsWhether results are related to plant protein itself or to other factors associated with more plant-based diets is difficult to establish.ConclusionsA diet with a higher proportion of protein from plant sources is associated with lower mortality in those with eGFR<60mL/min/1.73m(2). Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR<60mL/min/1.73m(2).Published by Elsevier Inc.

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