Association of artificial sweeteners intake and risk of CKD: a prospective cohort study

BACKGROUND: Artificial sweeteners (AS) are widely used in foods and beverages as low-calorie alternative, but their safety remains controversial. Robust epidemiological evidence regarding the impact of AS on kidney health, especially the risk of chronic kidney disease (CKD) is currently lacking. METHODS: The study included 156,000 participants from the UK Biobank cohort with a median follow-up of 13.3 years. The intake of AS from various sources was evaluated through a 24-h dietary recall. Incident CKD was defined as a newly diagnosed by the ICD codes and follow-up eGFR from study records and general practice data. Cox regression models were used to analyze the association between AS intakes and the risk of incident CKD, as well as the combined effects between genetic risk and AS intakes on incident CKD. RESULTS: Compared to None-AS group, high-AS group had higher risk of new-onset CKD after fully adjusted, with HR 1.19 (95% CI:1.08-1.30). Participants with high AS intakes and high polygenic risk had the greatest risk of CKD (HR = 1.49, 95% CI:1.28-1.74). In substitution analysis, replacing sugar with an equivalent sweetness from AS resulted in an HR of 1.02 (95% CI: 1.01-1.04) for incident CKD. CONCLUSIONS: AS intake is associated with an increased risk of incident CKD, an association that exists across all levels of CKD genetic risk. Substitution analysis indicate no advantage to using AS instead of sugar to reduce the risk of CKD. These findings provide essential evidence for reassessing the role of AS intake contributes to the new-onset CKD.