Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease

Abstract

Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied. An MD adherence score (MDS) (range 0–55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m2 in women and > 115 g/m2 in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 ± 13 vs. 55 ± 16 years; p < 0.001) had lower MDS (24 ± 2.7 vs. 25 ± 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 ± 2.7 vs. 3.9 ± 1.9; p < 0.05), body mass index (27.5 ± 4.9 vs. 24.1 ± 3.5 kg/m2; p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69–0.98; p < 0.05). MDS was inversely related to LVMI (r = −0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Β = −2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 ± 3.7) to concentric remodeling (25.8 ± 3.0), eccentric (24.0 ± 2.8), and then concentric (23.6 ± 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.

Effects of Mediterranean Diet, DASH Diet, and Plant-Based Diet on Outcomes among End Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis

“…Seventeen studies were further excluded as they either did not report outcomes of interest, excluded dialysis patients, did not evaluate the diet of interest, or had no separate analysis of ESKD outcomes. The final analysis included seven articles [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ], consisting of 9400 ESKD patients, from which 8395 were HD patients and 1005 were peritoneal dialysis (PD) patients. The literature retrieval, review, and selection process are demonstrated in Figure 1 .…”

“…Higher adherence to a Mediterranean diet was associated with decreased adverse cardiovascular outcome markers as measured by LVH in ESKD patients [ 16 ]. Becharaki et al [ 16 ] also showed that a higher Mediterranean diet score was associated with a lower prevalence of crescentic and eccentric cardiac geometry.…”

“…Higher adherence to a Mediterranean diet was associated with decreased adverse cardiovascular outcome markers as measured by LVH in ESKD patients [ 16 ]. Becharaki et al [ 16 ] also showed that a higher Mediterranean diet score was associated with a lower prevalence of crescentic and eccentric cardiac geometry. A prior meta-analysis that evaluated secondary cardiovascular outcomes for a Mediterranean diet in the general population did not show a significant association [ 43 ], however, they did not evaluate the geometry of the heart.…”

“…A recent systematic review also showed that each one-point-higher adherence to the Mediterranean diet was associated with a 10% reduction of progression of CKD [ 13 ]. However, the effects of the DASH diet on clinical outcomes among ESKD patients are inconsistent, and it remains unclear if it has any beneficial effect in this population [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Current dietary guidelines for ESKD patients usually recommend the restriction of specific nutrients (sodium, potassium, phosphorus, etc.)…”

“…However, there is limited evidence showing the clinical benefits of restricted nutrients in ESKD patients. The literature has been inconsistent regarding the benefits of a DASH diet in the chronic kidney disease population, and only a small number of studies are available in ESKD patients [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. In this systematic review, we evaluated the impact of a DASH, Mediterranean, or plant-based diet on clinical outcomes, including all-cause and cardiovascular mortality, left ventricular hypertrophy (LVH), and hyperkalemia in ESKD patients.…”