Association between alcohol consumption and all-cause mortality in patient undergoing hemodialysis

Patients on kidney dialysis face a mortality risk eight times higher than that of the general population. The impact of alcohol consumption among kidney dialysis patients remains unclear. A study evaluated the association between alcohol consumption and all-cause mortality in this population.
Researchers prospectively assessed alcohol intake using the food frequency questionnaire in kidney dialysis patients from Europe and Argentina. Alcohol consumption was divided as abstinent, occasional drinker (<14 g/day) and regular drinker (>14 g/day). Participants were followed until death or discharge from the dialysis unit. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular and non-cardiovascular mortality. Associations were examined using Cox proportional hazards (PH) models as the primary analysis and Fine and Gray competing risks models as secondary analysis, as well as a dose response analysis. Confounding by demographic, clinical and lifestyle factors was addressed using propensity score inverse probability weighting.
Among 7,917 participants, 22% were abstinent, 68% were occasional drinkers, and 11% were regular drinkers. Wine accounted for 77% of total alcohol consumed, with a mean intake was 26 g/day among regular drinkers. Over a median follow-up of 4.0 years, 3,753 deaths (36%) occurred. In the weighted and adjusted Cox PH model, all-cause mortality was lower among occasional drinkers (HR = 0.84; 95% CI: 0.75–0.95;), but not among regular drinkers (HR = 0.87; 95% CI: 0.71–1.06). Non-cardiovascular mortality was lower among occasional (HR = 0.81; 95% CI: 0.68–0.95) and regular drinkers (HR = 0.71; 95% CI: 0.53–0.95), whereas cardiovascular mortality showed no significant association. In the dose–response analysis, the unadjusted model showed a J-shaped curve, with the lowest relative risk around 10–15 g/day followed by a rise at higher intakes. After adjustment for covariates, the association was substantially attenuated but remained nonlinear.
In this large cohort of adults receiving maintenance kidney dialysis, moderate alcohol consumption was not associated with increased mortality. A possible protective association was observed among occasional drinkers, mainly for non-cardiovascular mortality, although residual confounding cannot be excluded.
Source: Heitz, Pierre-Henri, Bernier-Jean, Amélie, Saglimbene, Valeria, Strippoli, Giovanni, Association between Alcohol Consumption and All-Cause Mortality in Patients Undergoing Hemodialysis: A Survival Analysis from the DIET-HD Cohort. Clinical Journal of the American Society of Nephrology