Association between polyunsaturated fatty acids and progression among patients with diabetic kidney disease

Diabetic kidney disease (DKD) is the major complication of diabetes mellitus (DM) and one of the leading causes of end-stage renal disease. Early detection and treatment are contributing to delay the progression of DKD. Dietary management has potential benefits for DKD, especially the intake of polyunsaturated fatty acids (PUFAs). However, there is a lack of sufficient evidence, so we aimed to explore the association between PUFAs intake and DKD progression.

In the National Heath and Nutrition Examination Survey (NHANES) between 2011-2018, a cross-sectional study was conducted among adults with T2DM. DKD was diagnosed with urine albumin to creatinine ratio (ACR) ≥ 30 mg/g or estimated glomerular filtration rate (eGFR) ＜60 ml/min/1.73 m². Using Survey package of R to arrange the collected PUFAs intake data in order from small to large and divide them into four equal parts, which were expressed as Q1, Q2, Q3 and Q4 respectively. To investigate the association between PUFAs intake and DKD, a weighted univariate logistic regression analysis was performed and the odds ratio (OR) and 95% confidence interval (CI) were calculated for the association with DKD and PUFAs quartiles.

The study involved 3287 participants with T2DM, including 2043 non-DKD and 1244 DKD patients. The results showed that the intake of PUFAs was a protective factor for DKD (p = 0.022), and with the increase of the PUFAs, renal function improved in DKD patients, the adjusted mean of eGFR and Scr changing from 57 (41, 86) in Q1 to 71 (55, 101) ml/min in Q4 (p 0.001), 103 (73, 131) in Q1 to 90 (68, 117) in Q4 (p = 0.031), respectively.

Our study indicated that intake of more PUFAs may contribute to delay DKD progression, while different n-6/n-3 ratios need to be explored to protect the kidney.