Association of live microbes intake and risk of all-cause, cardiovascular disease, and cancer-related mortality in patients with chronic kidney disease

Chronic kidney disease (CKD) is a prevalent chronic, non-communicable disease. The long-term health effects of dietary live microbes, primarily probiotics, on CKD patients remain insufficiently understood. This study aims to investigate the association between dietary intake of live microbes and long-term health outcomes among individuals with CKD. Utilizing the National Health and Nutrition Examination Survey (NHANES) database, Cox regression analysis assessed the association between medium and high categories dietary live microbe intake and health outcomes (all-cause, cardiovascular disease [CVD], and cancer-related mortality) in CKD patients. A total of 3,646 CKD patients were enrolled. During the follow-up period, 1,593 all-cause mortality events were recorded, including 478 CVD deaths and 268 cancer deaths. In the fully adjusted model, compared to CKD patients in the lowest quartile (quartile 1) of live microbes intake, those in quartiles 3 and 4 exhibited a 20% and 26% reduced risk of all-cause mortality, with hazard ratios (HR) of 0.80 (95% confidence interval, CI: 0.69, 0.94) and 0.74 (95% CI: 0.62, 0.90), respectively. Additionally, compared to those with low live microbe intake (quartile 1), higher live microbe intake in quartile 4 was associated with a 37% reduction in the risk of CVD mortality for CKD patients, with an HR of 0.63 (95% CI: 0.45, 0.88). Consistent results were observed in subgroup and sensitivity analyses. A significant negative association was observed between live microbe intake and the risk of all-cause mortality as well as CVD mortality in the CKD population, with a p-value for trend < 0.05. Our study indicated that high dietary live microbe intake could mitigate the risk of all-cause and CVD mortality in CKD patients. These findings support the inclusion of live microbes in dietary recommendations, highlighting their significant roles in CKD.

慢性肾脏病（Chronic kidney disease, CKD）是一种流行的慢性非传染性疾病。膳食活性微生物（主要为益生菌）对CKD患者的长期健康影响仍未得到充分阐明。本研究旨在探讨膳食活性微生物摄入与CKD患者长期健康结局之间的关联。
本研究利用美国国家健康与营养调查（National Health and Nutrition Examination Survey, NHANES）数据库，通过Cox回归分析评估了中、高水平膳食活性微生物摄入与CKD患者健康结局（全因死亡、心血管疾病[Cardiovascular disease, CVD]及癌症相关死亡）之间的关联。
本研究共纳入3646名CKD患者。随访期间，共记录到1593例全因死亡事件，其中包括478例CVD相关死亡及268例癌症相关死亡。
在完全调整模型中，与膳食活性微生物摄入最低四分位组（第1四分位）的CKD患者相比，第3和第4四分位组患者的全因死亡风险分别降低20%和26%，风险比（hazard ratios, HR）分别为0.80（95%置信区间[confidence interval, CI]：0.69, 0.94）和0.74（95% CI：0.62, 0.90）。
此外，与低膳食活性微生物摄入者（第1四分位组）相比，第4四分位组高摄入的CKD患者CVD死亡风险降低37%，HR为0.63（95% CI：0.45, 0.88）。亚组分析与敏感性分析均得到了一致的结果。
在CKD人群中，膳食活性微生物摄入与全因死亡及CVD死亡风险呈显著负相关，趋势检验P值<0.05。本研究表明，高水平膳食活性微生物摄入可降低CKD患者的全因死亡及CVD死亡风险。上述研究结果支持将活性微生物纳入膳食推荐指南，凸显其在CKD防治中的重要作用。