Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study

Rationale & Objective: Ultraprocessed foods are widely consumed in the United States and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the gen-eral population. We investigated associations between ultraprocessed food intake and chronic kidney disease (CKD) progression, all-cause mortality, and incident CVD in adults with chronic kidney disease (CKD).Study Design: Prospective cohort study.Setting & Participants: Chronic Renal Insuffi-ciency Cohort Study participants who completed baseline dietary questionnaires. Exposure: Ultraprocessed food intake (in servings per day) classified according to the NOVA system. Outcomes: CKD progression (& GE;50% decrease in estimated glomerular filtration rate [eGFR] or initiation of kidney replacement therapy), all -cause mortality, and incident CVD (myocardial infarction, congestive heart failure, or stroke). Analytical Approach: Cox proportional hazards models adjusted for demographic, lifestyle, and health covariates.Results: There were 1,047 CKD progression events observed during a median follow-up of 7 years. Greater ultraprocessed food intake was associated with higher risk of CKD progression (tertile 3 vs tertile 1, HR, 1.22; 95% CI, 1.04-1.42; P = 0.01 for trend). The association differed by baseline kidney function, such that greater intake was associated with higher risk among people with CKD stages 1/2 (eGFR & GE;60 mL/min/1.73 m2; tertile 3 vs tertile 1, HR, 2.61; 95% CI, 1.32-5.18) but not stages 3a-5 (eGFR<6 0 mL/min/1.73 m2; P = 0.003 for interaction). There were 1,104 deaths observed during a median follow-up of 14 years. Greater ultraprocessed food intake was associated with higher risk of mortality (tertile 3 vs tertile 1, HR, 1.21; 95% CI, 1.04-1.40; P = 0.004 for trend).Limitations: Self-reported diet.Conclusions: Greater ultraprocessed food intake may be associated with CKD progression in earlier stages of CKD and is associated with higher risk of all-cause mortality in adults with CKD.