PURE healthy diet score, genetic susceptibility, and incident chronic kidney disease

<i>Background</i>: By using the Prospective Urban Rural Epidemiology (PURE) score-a novel dietary pattern that includes exclusively protective foods-we investigated the relationship between PURE score and the risk of chronic kidney disease (CKD), and compared its performance with some conventional dietary patterns, including the Dietary Approaches to Stop Hypertension (DASH), Alternate Mediterranean diet (aMed), Alternate Healthy Eating Index-2010 (AHEI-2010), and healthful Plant-Based Diet Index (hPDI). <i>Methods</i>: 179 569 participants without CKD at the baseline from the UK Biobank were included. Dietary information was collected through 24-hour dietary questionnaires. The PURE score was calculated based on six foods (fruits, vegetables, legumes, nuts, fish, and dairy), ranging from 6 to 30. The study outcome was incident CKD. <i>Results</i>: During a median follow-up of 12.1 years, 4822 participants developed CKD. The PURE score was inversely associated with incident CKD (per 1 quintile increment: HR, 0.92; 95%CI, 0.90-0.94). Compared with participants with PURE score <14 (unhealthy PURE score), those with PURE score ≥14 (healthy PURE score) had a significantly 19% (95%CI, 13%-23%) lower risk of CKD. Genetic risk of CKD, DASH, aMed, AHEI-2010, and hPDI did not significantly modify the association between PURE score and incident CKD (all <i>P</i> for interactions >0.05). None of the conventional dietary patterns (per 1 quintile increment: HRs ranging from 0.91 to 0.96) was significantly superior to PURE score in reducing the risk of CKD. <i>Conclusions</i>: Adherence to a high PURE score was associated with a lower risk of CKD, suggesting the importance of protective foods in CKD prevention.