Introduction: Diet soda consumption may be associated with kidney disease, as shown in Caucasian women, due to phosphorus content, by increasing dietary acid load, or as a proxy for poor diet quality. However, less is known about the relationship between diet soda consumption and end-stage renal disease (ESRD) risk in the general population.
Methods: We conducted a prospective analysis of time-varying diet soda consumption and incident ESRD in the population-based Atherosclerosis Risk in Communities study (N=15,369) using Cox regression. Usual dietary intake was assessed by a food frequency questionnaire in 1987-89 (baseline) and 1993-95. Incident ESRD was defined as initiation of renal replacement therapy (transplant, dialysis) through 2011.
Results: Baseline mean age was 54 years, 55% were female, 27% were African-American, 12% had diabetes, and 35% had hypertension. Approximately a third of participants consumed <1 glass of diet soda per month; 42% of participants consumed up to 6 glasses/week; and 22% consumed more than 6 glasses/week. Over a median follow-up of 23 years, 357 incident ESRD cases were observed. Consuming up to 6 glasses of diet soda per week and more than 6 glasses of diet soda per week, respectively, was associated with 1.28-times (95% CI: 0.96, 1.70; p=0.10) and 1.95-times (95% CI: 1.43, 2.64; p<0.001) greater risk of ESRD relative to <1 glass/month after adjusting for total caloric intake, sugar-sweetened beverages, diet quality, age, sex, race-center, estimated glomerular filtration rate, diabetes, hypertension, overweight/obesity status, education level, smoking status, and physical activity (p-value for trend <0.001; Figure). For each additional glass of diet soda consumed per day, there was a 26% higher risk of ESRD (HR: 1.26; 95% CI: 1.14, 1.40; p<0.001). Sugar-sweetened beverage consumption was not association with ESRD.
Conclusion: Diet soda consumption was associated with ESRD risk and may be an important target for dietary interventions aimed at slowing kidney disease progression.