Advertisement

Can Comprehensive Lifestyle Change Alter the Course of Chronic Kidney Disease?

      Summary

      Comprehensive lifestyle change can impact health favorably in many domains, from prevention and treatment of various diseases to improved functional status and quality of life. Although habitual behaviors clearly influence chronic kidney disease (CKD), lifestyle change often is not stressed in the clinical setting. The purpose of this review is to provide a critical appraisal of the scientific basis for effects of lifestyle on CKD and practical strategies that promote healthy behaviors. This review begins with a clinical case presentation to provide context for the scientific discussion. Dietary composition of macronutrients, particularly protein intake, is highlighted. Clinical evidence is presented for avoiding protein excess, a contemporary problem in the typical overeating environment of the developed world. Concomitant approaches to balancing intake of carbohydrates and fats also are presented. Integration of sodium reduction with macronutrient adjustment is reviewed within the framework of managing blood pressure in the setting of CKD. Considering the emerging body of evidence for obesity-related CKD and associated complications, weight control is addressed from the standpoint of decreasing calories and increasing exercise. Finally, effects of smoking and alcohol use on CKD are discussed. In the spirit of active participation, which is essential to lifestyle change, the discussion returns full circle to a concluding statement from the clinical case patient who provides his point of view on lifestyle change while living with CKD.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Seminars in Nephrology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brenner B.M.
        • Meyer T.W.
        • Hostetter T.H.
        Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease.
        N Engl J Med. 1982; 307: 652-659
        • Hostetter T.H.
        • Meyer T.W.
        • Rennke H.G.
        • Brenner B.M.
        Chronic effects of dietary protein in the rat with intact and reduced renal mass.
        Kidney Int. 1986; 30: 509-517
        • Zatz R.
        • Meyer T.W.
        • Rennke H.G.
        • Brenner B.M.
        Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy.
        Proc Natl Acad Sci U S A. 1985; 82: 5963-5967
        • Tuttle K.R.
        • Bruton J.L.
        • Perusek M.C.
        • Lancaster J.L.
        • Kopp D.T.
        • DeFronzo R.A.
        Effect of strict glycemic control on renal hemodynamic response to amino acids and renal enlargement in insulin-dependent diabetes mellitus.
        N Engl J Med. 1991; 324: 1626-1632
        • Tuttle K.R.
        • Bruton J.L.
        Effect of insulin therapy on renal hemodynamic response to amino acids and renal hypertrophy in non-insulin-dependent diabetes.
        Kidney Int. 1992; 42: 167-173
        • Tuttle K.R.
        • Puhlman M.E.
        • Cooney S.K.
        • Short R.A.
        Effects of amino acids and glucagon on renal hemodynamics in type 1 diabetes.
        Am J Physiol Renal Physiol. 2002; 282: F103-F112
        • Uribarri J.
        • Tuttle K.R.
        Advanced glycation end products and nephrotoxicity of high protein diets.
        Clin J Am Soc Nephrol. 2006; 1: 1293-1299
        • Finot P.A.
        Historical perspective of the Maillard reaction in food science.
        Ann N Y Acad Sci. 2005; 1043: 1-8
        • Anderson M.M.
        • Requena J.R.
        • Crowley J.R.
        • Thorpe S.R.
        • Heinecke J.W.
        The myeloperoxidase system of human phagocytes generates N epsilon-(carboxymethyl)lysine on proteins: a mechanism for producing advanced glycation end products at sites of inflammation.
        J Clin Invest. 1999; 104: 103-113
        • Anderson M.M.
        • Heinecke J.W.
        Production of N epsilon-(carboxymethyl)lysine is impaired in mice deficient in NADPH oxidase.
        Diabetes. 2003; 52: 2137-2143
        • Silbiger S.
        • Crowley S.
        • Shan Z.
        • Brownlee M.
        • Satriano J.
        • Schlondorff D.
        Nonenzymatic glycation of mesangial matrix and prolonged exposure of mesangial matrix to elevated glucose reduces collagen synthesis and proteoglycan charge.
        Kidney Int. 1993; 43: 853-864
        • Mott J.D.
        • Khalifah R.G.
        • Nagase H.
        • Shield 3rd, C.F.
        • Hudson J.K.
        • Hudson B.G.
        Nonenzymatic glycation of type IV collagen and matrix metalloproteinase susceptibility.
        Kidney Int. 1997; 52: 1302-1312
        • Krishnamurti U.
        • Rondeau E.
        • Sraer J.D.
        • Michael A.F.
        • Tsilibary E.C.
        Alterations in human glomerular epithelial cells interacting with nonenzymatically glycosylated matrix.
        J Biol Chem. 1997; 272: 27966-27970
        • Charonis A.S.
        • Tsilbary E.C.
        Structural and functional changes of laminin and type IV collagen after nonenzymatic glycation.
        Diabetes. 1992; 41: S49-S51
        • Lee H.B.
        • Yu M.R.
        • Yang Y.
        • Jiang Z.
        • Ha H.
        Reactive oxygen species-regulated signaling pathways in diabetic nephropathy.
        J Am Soc Nephrol. 2003; 14: S241-S245
        • Zhou G.
        • Li C.
        • Cai L.
        Advanced glycation end-products induce connective tissue growth factor-mediated renal fibrosis predominantly through transforming growth factor beta-independent pathway.
        Am J Pathol. 2004; 165: 2033-2043
        • Huang J.S.
        • Guh J.Y.
        • Chen H.C.
        • Hung W.C.
        • Lai Y.H.
        • Chuang L.Y.
        Role of receptor for advanced glycation end-product (RAGE) and the JAK/STAT-signaling pathway in AGE-induced collagen production in NRK-49F cells.
        J Cell Biochem. 2001; 81: 102-113
        • Twigg S.M.
        • Cao Z.
        • McLennan S.V.
        • Burns W.C.
        • Brammar G.
        • Forbes J.M.
        • et al.
        Renal connective tissue growth factor induction in experimental diabetes is prevented by aminoguanidine.
        Endocrinology. 2002; 143: 4907-4915
        • Goldberg T.
        • Cai W.
        • Peppa M.
        • Dardaine V.
        • Baliga B.S.
        • Uribarri J.
        • et al.
        Advanced glycoxidation end products in commonly consumed foods.
        J Am Diet Assoc. 2004; 104: 1287-1291
        • Uribarri J.
        • Cai W.
        • Sandu O.
        • Peppa M.
        • Goldberg T.
        • Vlassara H.
        Diet-derived glycation end products are major contributors to the body's AGE pool and induce inflammation in healthy subjects.
        Ann N Y Acad Sci. 2005; 1043: 461-466
        • Tuttle K.R.
        • Johnson E.C.
        • Cooney S.K.
        • Anderberg R.J.
        • Johnson E.K.
        • Clifton G.D.
        • et al.
        Amino acids injure mesangial cells by advanced glycation end products, oxidative stress, and protein kinase C.
        Kidney Int. 2005; 67: 953-968
        • Tuttle K.R.
        • Anderberg R.
        • Cooney S.
        • Meek R.
        Oxidative stress mediates protein kinase C activation and advanced glycation end product formation in a mesangial cell model of diabetes and high protein diet.
        Am J Nephrol. 2009; 29: 171-180
        • Cai W.
        • Gao Q.D.
        • Zhu L.
        • Peppa M.
        • He C.J.
        • Vlassara H.
        Oxidative stress-inducing carbonyl compounds from common foods: novel mediators of cellular dysfunction.
        Mol Med. 2002; 8: 337-346
        • Cai W.
        • He J.C.
        • Zhu L.
        • Peppa M.
        • Lu C.
        • Uribarri J.
        • et al.
        High levels of dietary advanced glycation end products transform low-density lipoprotein into a potent redox-sensitive mitogen-activated protein kinase stimulant in diabetic patients.
        Circulation. 2004; 110: 285-291
        • Vlassara H.
        • Cai W.
        • Crandall J.
        • Goldberg T.
        • Oberstein R.
        • Dardaine V.
        • et al.
        Inflammatory mediators are induced by dietary glycotoxins, a major risk factor for diabetic angiopathy.
        Proc Natl Acad Sci U S A. 2002; 99: 15596-15601
        • Uribarri J.
        • Peppa M.
        • Cai W.
        • Goldberg T.
        • Lu M.
        • He C.
        • et al.
        Restriction of dietary glycotoxins reduces excessive advanced glycation end products in renal failure patients.
        J Am Soc Nephrol. 2003; 14: 728-731
        • Peppa M.
        • Uribarri J.
        • Cai W.
        • Lu M.
        • Vlassara H.
        Glycoxidation and inflammation in renal failure patients.
        Am J Kidney Dis. 2004; 43: 690-695
        • Tanji N.
        • Markowitz G.S.
        • Fu C.
        • Kislinger T.
        • Taguchi A.
        • Pischetsrieder M.
        • et al.
        Expression of advanced glycation end products and their cellular receptor RAGE in diabetic nephropathy and nondiabetic renal disease.
        J Am Soc Nephrol. 2000; 11: 1656-1666
        • Wrone E.M.
        • Carnethon M.R.
        • Palaniappan L.
        • Fortmann S.P.
        Association of dietary protein intake and microalbuminuria in healthy adults: Third National Health and Nutrition Examination Survey.
        Am J Kidney Dis. 2003; 41: 580-587
        • Knight E.L.
        • Stampfer M.J.
        • Hankinson S.E.
        • Spiegelman D.
        • Curhan G.C.
        The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency.
        Ann Intern Med. 2003; 138: 460-467
        • Hoogeveen E.K.
        • Kostense P.J.
        • Jager A.
        • Heine R.J.
        • Jakobs C.
        • Bouter L.M.
        • et al.
        Serum homocysteine level and protein intake are related to risk of microalbuminuria: the Hoorn Study.
        Kidney Int. 1998; 54: 203-209
        • Bernstein A.M.
        • Treyzon L.
        • Zhaoping L.
        Are high-protein diet, vegetable-based diets safe for kidney function?.
        J Am Diet Assoc. 2007; 17: 644-650
        • Foster G.D.
        • Wyatt H.R.
        • Hill J.O.
        • McGuckin B.G.
        • Brill C.
        • Mohammed B.S.
        • et al.
        A randomized trial of a low-carbohydrate diet for obesity.
        N Engl J Med. 2003; 348: 2082-2090
        • Yancy Jr, W.S.
        • Olsen M.K.
        • Guyton J.R.
        • Bakst R.P.
        • Westman E.C.
        A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial.
        Ann Intern Med. 2004; 140: 769-777
        • Brehm B.J.
        • Seeley R.J.
        • Daniels S.R.
        • D'Alessio D.A.
        A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women.
        J Clin Endocrinol Metab. 2003; 88: 1617-1623
        • Stern L.
        • Iqbal N.
        • Seshadri P.
        • Chicano K.L.
        • Daily D.A.
        • McGrory J.
        • et al.
        The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.
        Ann Intern Med. 2004; 140: 778-785
        • Pedrini M.T.
        • Levey A.S.
        • Lau J.
        • Chalmers T.C.
        • Wang P.H.
        The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis.
        Ann Intern Med. 1996; 124: 627-632
        • Kasiske B.L.
        • Lakatua J.D.
        • Ma J.Z.
        • Louis T.A.
        A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function.
        Am J Kidney Dis. 1998; 31: 954-961
        • Pan Y.
        • Guo L.L.
        • Hui M.J.
        Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials.
        Am J Clin Nutr. 2008; 88: 660-666
        • Fouque D.
        • Laville M.
        • Boissel J.P.
        • Chifflet R.
        • Labeeuw M.
        • Zech P.Y.
        Controlled low protein diets in chronic renal insufficiency: meta-analysis.
        BMJ. 1992; 304: 216-220
        • Fouque D.
        • Wang P.
        • Laville M.
        • Boissel J.P.
        Low protein diets delay end-stage renal disease in non-diabetic adults with chronic renal failure.
        Nephrol Dial Transplant. 2000; 15: 1986-1992
        • Fouque D.
        • Laville M.
        • Boissel J.P.
        Low protein diets for chronic kidney disease in non-diabetic adults.
        Cochrane Database Syst Rev. 2006; 2 (CD001892)
        • Klahr S.
        • Levey A.S.
        • Beck G.J.
        • Caggiula A.W.
        • Hunsicker L.
        • Kusek J.W.
        • et al.
        The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease.
        N Engl J Med. 1994; 330: 877-884
        • Levey A.S.
        • Greene T.
        • Beck G.J.
        • Caggiula A.W.
        • Kusek J.W.
        • Hunsicker L.G.
        • et al.
        Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown?.
        J Am Soc Nephrol. 1999; 10: 2426-2439
        • Hansen H.P.
        • Tauber-Lassen E.
        • Jensen B.R.
        • Parving H.H.
        Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy.
        Kidney Int. 2002; 62: 220-228
      1. Dietary intake of ten key nutrients for public health, United States: 1999-2000.
        ([cited 2008 December])
        • National Academy of Sciences, Institute of Medicine
        Dietary reference intakes for energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein and amino acids (Macronutrients).
        (Chapter 8) The National Academy Press, Washington, DC2002
        • American Diabetes Association
        ADA standards of medical care in diabetes—2008.
        Diabetes Care. 2008; 31: S20-S21
        • American Heart Association
        Step I, step II, and TLC diets.
        ([cited 2008 December])
        • Hamazaki T.
        • Takazakura E.
        • Osawa K.
        • Urakaze M.
        • Yano S.
        Reduction in microalbuminuria in diabetics by eicosapentaenoic acid ethyl ester.
        Lipids. 1990; 9: 541-545
        • Dullart R.P.
        • Beusekamp B.J.
        • Meijer S.
        • Hoogenberg K.
        • van Doormaal J.J.
        • Sluiter W.J.
        Long-term effects of linoleic-acid-enriched diet on albuminuria and lipid levels in type 1 (insulin-dependent) diabetic patients with elevated urinary albumin excretion.
        Diabetologia. 1992; 35: 165-172
        • Bouhanick B.
        • Suraniti S.
        • Berrut G.
        • Bled F.
        • Simard G.
        • Lejeune J.J.
        • et al.
        Relationship between fat intake and glomerular filtration rate in normotensive insulin-dependent diabetic patients.
        Diabetes Metab. 1995; 21: 168-172
        • Rossing P.
        • Hansen B.V.
        • Nielsen F.S.
        • Myup B.
        • Holmer G.
        • Parving H.H.
        Fish oil in diabetic nephropathy.
        Diabetes Care. 1996; 19: 1214-1219
        • Mollsten A.
        • Dahlquist G.
        • Stattin Eva-Lena
        • Rudberg S.
        Higher intakes of fish protein are related to a lower risk of microalbuminuria in young Swedish type 1 diabetic patients.
        Diabetes Care. 2001; 24: 805-811
        • National Kidney Foundation
        KDOQI clinical practice guidelines for cardiovascular disease in dialysis patients.
        Am J Kidney Dis. 2005; 45: S90-S95
        • Kris-Etherton P.
        • William H.
        • Appel L.
        Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease.
        Circulation. 2002; 106: 2747-2757
        • Sacks F.M.
        • Svetkey L.P.
        • Vollmer W.M.
        • Appel L.J.
        • Bray G.A.
        • Harsha D.
        • et al.
        Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet.
        N Engl J Med. 2001; 344: 3-10
        • He J.
        • Gu D.
        • Wu X.
        • Chen J.
        • Duan X.
        • Chen J.
        • et al.
        Effect of soybean protein on blood pressure: a randomized, controlled trial.
        Ann Intern Med. 2005; 143: 1-9
        • Appel L.J.
        • Sacks F.M.
        • Carey V.J.
        • Obarzanek E.
        • Swain J.F.
        • Miller 3rd, E.R.
        • et al.
        • OmniHeart Collaborative Research Group
        Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.
        JAMA. 2005; 294: 2455-2464
        • Azadbakht L.
        • Shakerhosseini R.
        • Atabak S.
        • Jamshidian M.
        • Mehrabi Y.
        • Esmaill-Zadeh A.
        Beneficiary effect of dietary soy protein on lowering plasma levels of lipid and improving kidney function in type II diabetes with nephropathy.
        Eur J Clin Nutr. 2003; 57: 1292-1294
        • Pecis M.
        • Azevedo M.
        • Gross J.
        Chicken and fish diet reduces glomerular hyperfiltration in IDDM patients.
        Diabetes Care. 1994; 17: 665-672
        • Jibani M.M.
        • Bloodworth L.L.
        • Foden E.
        • Griffiths K.D.
        • Galpin O.P.
        Predominantly vegetarian diet in patients with incipient and early clinical diabetic nephropathy: effects on albumin excretion rate and nutritional status.
        Diabetic Med. 1991; 8: 949-953
        • Cutler J.A.
        • Obarzanek E.
        Nutrition and blood pressure: is protein one link?.
        Ann Intern Med. 2005; 143: 74-75
        • Flegal K.M.
        • Graubard B.I.
        • Williamson D.F.
        • Gail M.H.
        Cause-specific excess deaths associated with underweight, overweight, and obesity.
        JAMA. 2007; 298: 2028-2037
        • Wang Y.
        • Chen X.
        • Song Y.
        • Caballero B.
        • Cheskin L.J.
        Association between obesity and kidney disease: a systematic review and meta-analysis.
        Kidney Int. 2007; 73: 19-33
        • Muntner P.
        • Winston J.
        • Uribarri J.
        • Mann D.
        • Fox C.S.
        Overweight, obesity, and elevated cystatin C levels in adults in the United States.
        Am J Med. 2008; 121: 341-348
        • Hsu C.-Y.
        • McCulloch C.E.
        • Iribarren C.
        • Darbinian J.
        • Go A.S.
        Body mass index and risk for end-stage renal disease.
        Ann Intern Med. 2006; 144: 21-28
        • World Health Organization (WHO)
        Obesity: preventing and managing the global epidemic: report of a WHO consultation on obesity, Geneva, June 3-5, 1997.
        World Health Organization, Geneva1998
        • Elsayed E.F.
        • Tighiouart H.
        • Weiner D.E.
        • Griffith J.
        • Salem D.
        • Levey A.S.
        • et al.
        Waist-to-hip ratio and body mass index as risk factors for cardiovascular events in CKD.
        Am J Kidney Dis. 2008; 52: 49-57
        • Griffin K.A.
        • Kramer H.
        • Bidani A.K.
        Adverse renal consequences of obesity.
        Am J Physiol Renal Phys. 2008; 294: F685-F696
        • Poirier P.
        • Giles T.D.
        • Bray G.A.
        • Hong Y.
        • Stern J.S.
        • Pi-Sunyer F.X.
        • et al.
        Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism.
        Circulation. 2006; 113: 898-918
        • Orchard T.J.
        • Temprosa M.
        • Goldberg R.
        • Haffner S.
        • Ratner R.
        • Marcovina S.
        • et al.
        The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial.
        Ann Intern Med. 2005; 142: 611-619
        • Morales E.
        • Valero M.A.
        • Leon M.
        • Hernandez E.
        • Praga M.
        Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies.
        Am J Kidney Dis. 2003; 41: 319-327
      2. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease.
        Am J Kidney Dis. 2007; 49 (Anonymous): S95-S107
        • Kramer H.
        • Tuttle K.R.
        • Leehey D.
        • Luke A.
        • Durazo-Arvizu R.
        • Shoham D.
        • et al.
        Obesity management in adults with chronic kidney disease.
        Am J Kidney Dis. 2009; 53: 151-165
        • Snow V.
        • Barry P.
        • Fitterman N.
        • Qaseem A.
        • Weiss K.
        Clinical Efficacy Assessment Subcommittee of the American College of Physicians.
        Ann Intern Med. 2005; 142: 525-531
        • Chen J.
        • Muntner P.
        • Hamm L.L.
        • Batuman V.
        • Fonseca V.
        • Whelton P.K.
        • et al.
        Insulin resistance and risk of chronic kidney disease in nondiabetic US adults.
        J Am Soc Nephrol. 2003; 14: 469-477
        • Chen J.
        • Muntner P.
        • Hamm L.L.
        • Jones D.W.
        • Batuman V.
        • Fonseca V.
        • et al.
        The metabolic syndrome and chronic kidney disease in U.S. adults.
        Ann Intern Med. 2004; 140: 167-174
        • Bagby S.P.
        Obesity-initiated metabolic syndrome and the kidney: a recipe for chronic kidney disease?.
        J Am Soc Nephrol. 2004; 15: 2775-2791
        • Tuttle K.R.
        Renal manifestations of the metabolic syndrome.
        Nephrol Dial Transplant. 2005; 20: 861-864
        • Packard D.P.
        • Milton J.E.
        • Shuler L.A.
        • Short R.A.
        • Tuttle K.R.
        Implications of chronic kidney disease for dietary treatment of cardiovascular disease.
        J Renal Nutr. 2006; 16: 259-268
        • Eckel R.H.
        Clinical practice.
        N Engl J Med. 2008; 358: 1941-1950
        • Venkataraman R.
        • Sanderson B.
        • Bittner V.
        Outcomes in patients with chronic kidney disease undergoing cardiac rehabilitation.
        Am Heart J. 2005; 150: 1140-1146
        • Heiwe S.
        • Clyne N.
        • Tollback A.
        • Borg K.
        Effects of regular resistance training on muscle histopathology and morphometry in elderly patients with chronic kidney disease.
        Am J Phys Med Rehabil. 2005; 84: 865-874
        • Moinuddin I.
        • Leehey D.J.
        A comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease.
        Adv Chronic Kidney Dis. 2008; 15: 83-96
        • Chuahirun T.
        • Wesson D.E.
        Cigarette smoking predicts faster progression of type 2 established diabetic nephropathy despite angiotensin converting enzyme inhibition.
        Am J Kidney Dis. 2002; 39: 376-382
        • Phisitkul K.
        • Hegazy K.
        • Chuahirun T.
        • Hudson C.
        • Simoni J.
        • Rajab H.
        • et al.
        Continued smoking exacerbates but cessation ameliorates progression of early type 2 diabetic nephropathy.
        Am J Med Sci. 2008; 335: 284-291
        • Schaeffner E.S.
        • Kurth T.
        • de Jong P.E.
        • Glynn R.J.
        • Buring J.E.
        • Gaziano M.
        Alcohol consumption and the risk of renal dysfunction in apparently healthy men.
        Arch Intern Med. 2005; 165: 1048-1053
        • Knight E.L.
        • Stampfer M.J.
        • Rimm E.B.
        • Hankinson S.E.
        • Curhan G.C.
        Moderate alcohol intake and renal function decline in women: a prospective study.
        Nephrol Dial Transplant. 2003; 18: 1549-1554