The association between the healthy eating index and all-cause mortality in U.S. patients with chronic kidney disease: Evidence from NHANES.

BACKGROUND: Epidemiological evidence on the relationship between the Healthy Eating Index (HEI-2015) and mortality in chronic kidney disease (CKD) populations is limited. This study aimed to assess the association between HEI-2015 scores and all-cause mortality in CKD patients. METHODS: This cohort study included 7,360 CKD patients using data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018, with follow-up until December 31, 2019. All-cause mortality was determined using National Death Index (NDI) records. We applied weighted Cox regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) between HEI-2015 and all-cause mortality. RESULTS: Over a median follow-up of 78 months, 2,437 CKD patients died from all causes. After adjusting for confounders, individuals in the highest tertile of HEI-2015 scores had a lower risk of all-cause mortality compared to those in the lowest tertile, with an HR of 0.55 (95% CI: 0.34-0.89). Additionally, each standard deviation increase in HEI-2015 was associated with an HR of 0.73 (95% CI: 0.60-0.90) for all-cause mortality. Kaplan-Meier survival and restricted cubic regression spline analyses revealed a significant negative correlation between HEI-2015 and mortality risk (P<0.05), which was supported by sensitivity analysis. CONCLUSIONS: Higher HEI-2015 scores are significantly associated with a reduced risk of mortality in CKD patients, highlighting the importance of improving HEI-2015 scores in high-risk CKD populations to reduce mortality risk.