# Association of dietary carbohydrate intake with risk of mortality in maintenance hemodialysis patients: a multicenter prospective cohort study

## TL;DR

High carbohydrate intake is linked to increased mortality risk in hemodialysis patients, especially when combined with low energy intake.

## Contribution

Identifies the individual and combined effects of dietary carbohydrate and energy intake on mortality in hemodialysis patients.

## Key findings

- Patients with high carbohydrate intake (≥72.1%) had higher all-cause and CVD mortality risk.
- Those with high carbohydrate and low energy intake had the worst survival outcomes.
- The association was strongest in the highest carbohydrate intake quartile.

## Abstract

Current evidence on the relationship between dietary carbohydrate intake (DCI) and mortality risk among patients undergoing maintenance hemodialysis (MHD) is limited. Moreover, the joint impact of DCI and dietary energy intake (DEI) on mortality remains unclear. Therefore, we aimed to investigate both the individual and combined associations of DCI and DEI with all-cause and cardiovascular disease (CVD) mortality.

This study included 1044 MHD patients from eight outpatient dialysis centers across China. The DCI, expressed as a percentage of carbohydrate intake in total energy intake, was determined via 24-h dietary recalls over 3 days. The study outcomes included all-cause and CVD mortality. Cox proportional hazard models were utilized to evaluate both the individual and combined associations of DCI and DEI with mortality risk.

During a median follow-up of 45.6 months, 352 deaths were recorded, of which 206 (58.5%) were due to CVD. When DCIs were assessed as quartiles, patients in the fourth quartile (≥72.1%) were associated with a greater risk of all-cause mortality [hazard ratio (HR) 2.16; 95% confidence interval (CI) 1.10, 4.25] than patients in the first quartile (<61.5%), whereas patients in the second quartile (61.5%–66.7%; HR 1.27; 95% CI 0.87, 1.87) and the third quartile (66.7%–72.1%; HR 1.40; 95% CI 0.84, 2.31) were not significantly different. A similar trend was found for CVD mortality. When analyzed jointly, patients with high DCIs (≥72.1%) and low DEIs (<25 kcal/kg/day) had the highest risk of all-cause and CVD mortality.

A higher DCI was associated with a higher risk of all-cause and CVD mortality in MHD patients. Patients with high DCIs and low DEIs had a worse survival prognosis.

Graphical Abstract