• Valeria M Saglimbene, Germaine Wong, Marinella Ruospo, Suetonia C Palmer, Vanessa Garcia-Larsen, Patrizia Natale, Armando Teixeira-Pinto, Katrina L Campbell, Juan-Jesus Carrero, Peter Stenvinkel, Letizia Gargano, Angelo M Murgo, David W Johnson, Marcello Tonelli, Rubén Gelfman, Eduardo Celia, Tevfik Ecder, Amparo G Bernat, Domingo Del Castillo, Delia Timofte, Marietta Török, Anna Bednarek-Skublewska, Jan Duława, Paul Stroumza, Susanne Hoischen, Martin Hansis, Elisabeth Fabricius, Paolo Felaco, Charlotta Wollheim, Jörgen Hegbrant, Jonathan C Craig, and StrippoliGiovanni F MGFMFaculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia.Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.Department of Emergency and Organ Transplantation, University of Bar.
• Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; vsag1982@gmail.com.
• Clin J Am Soc Nephrol. 2019 Feb 7; 14 (2): 250-260.

Background And ObjectivesHigher fruit and vegetable intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in patients on hemodialysis, in whom high fruit and vegetable intake is generally discouraged because of a potential risk of hyperkalemia. We aimed to evaluate the association between fruit and vegetable intake and mortality in hemodialysis.Design, Setting, Participants, & MeasurementsFruit and vegetable intake was ascertained by the Global Allergy and Asthma European Network food frequency questionnaire within the Dietary Intake, Death and Hospitalization in Adults with ESKD Treated with Hemodialysis study, a multinational cohort study of 9757 adults on hemodialysis, of whom 8078 (83%) had analyzable dietary data. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association between tertiles of fruit and vegetable intake with all-cause, cardiovascular, and noncardiovascular mortality. Estimates were calculated as hazard ratios with 95% confidence intervals (95% CIs).ResultsDuring a median follow up of 2.7 years (18,586 person-years), there were 2082 deaths (954 cardiovascular). The median (interquartile range) number of servings of fruit and vegetables was 8 (4-14) per week; only 4% of the study population consumed at least four servings per day as recommended in the general population. Compared with the lowest tertile of servings per week (0-5.5, median 2), the adjusted hazard ratios for the middle (5.6-10, median 8) and highest (>10, median 17) tertiles were 0.90 (95% CI, 0.81 to 1.00) and 0.80 (95% CI, 0.71 to 0.91) for all-cause mortality, 0.88 (95% CI, 0.76 to 1.02) and 0.77 (95% CI, 0.66 to 0.91) for noncardiovascular mortality and 0.95 (95% CI, 0.81 to 1.11) and 0.84 (95% CI, 0.70 to 1.00) for cardiovascular mortality, respectively.ConclusionsFruit and vegetable intake in the hemodialysis population is low and a higher consumption is associated with lower all-cause and noncardiovascular death.Copyright © 2019 by the American Society of Nephrology.

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