Low Dietary Bromide Intake and Sex-Specific Mortality in Kidney Transplant Recipients
6 affiliations
- 1Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- 2Department of Health Sciences, Division of Nursing Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- 3Department of Dietetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- 4Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- 5Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- 6Division of Food Science, Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
Abstract
Background: Low bromide intake may be a modifiable risk factor for reduced survival among kidney transplant recipients (KTRs).
Objectives: We investigated dietary determinants of 24-h urinary bromide excretion and examined the association between 24-h urinary bromide excretion and mortality. Given potential sex differences, additional sex-stratified analyses were performed.
Methods: Adult KTRs from the TransplantLines Food & Nutrition Biobank and Cohort Study were included. Dietary determinants of urinary bromide excretion were assessed with multivariable linear regression. Associations of 24-h urinary bromide excretion were evaluated using multivariable sex-stratified Cox regression analyses.
Results: The study included 693 KTRs (43% female; mean age 53 ± 13 y). Urinary bromide excretion was lower in females than in males [median: 2958 (IQR: 2343–3713)] compared with median: 3640 [IQR: 2853–4585] μg/24 h; P < 0.001}. Energy intake (β = 0.12, P = 0.002), animal protein intake (β = 0.16, P = 0.001), and water intake (β = 0.13, P = 0.005) were positively associated with urinary bromide excretion. In sex-stratified analyses, animal protein intake was a significant determinant of bromide excretion in females (β = 0.22, P = 0.002), whereas water (β = 0.15, P = 0.02) and energy intake (β = 0.13, P = 0.01) were associated with bromide excretion in males. During a median follow-up of 5.3 (IQR: 4.8–6.1) years, 150 KTRs (21.6%) died. Higher urinary bromide excretion was consistently associated with a lower risk of mortality, even after adjustment for potential confounders [hazard ratio [HR]: 0.67 [95% confidence interval (CI): 0.50, 0.90]; P = 0.008]. The association of urinary bromide excretion with mortality was significantly modified by sex (Pinteraction = 0.02). Among females, there was a significant independent association between higher urinary bromide excretion and lower mortality [HR: 0.45 (95% CI: 0.29;0.72), P = 0.001], whereas no such association was observed in males.
Conclusions: Energy, animal protein, and water intake were positively associated with urinary bromide excretion, with sex-specific differences. Lower urinary bromide excretion was independently associated with increased all-cause mortality in female, but not in male KTRs. These findings support further investigation into whether improving bromide status could reduce mortality, particularly among female KTRs.
This trial was registered at clinicaltrials.gov as NCT02811835.
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BibTeX
@article{veen2026dietary,
title = {{Low Dietary Bromide Intake and Sex-Specific Mortality in Kidney Transplant Recipients}},
author = {Yvonne van der Veen and Caecilia SE Doorenbos and Daan Kremer and Daan J Touw and Eva Corpeleijn and Gerald Rimbach and Coby Annema and Casper FM Franssen and Stephan JL Bakker and Adrian Post},
journal = {Current Developments in Nutrition},
year = {2026},
month = sep,
doi = {10.1016/j.cdnut.2026.109543},
url = {https://doi.org/10.1016/j.cdnut.2026.109543},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Low Dietary Bromide Intake and Sex-Specific Mortality in Kidney Transplant Recipients
AU - Yvonne van der Veen
AU - Caecilia SE Doorenbos
AU - Daan Kremer
AU - Daan J Touw
AU - Eva Corpeleijn
AU - Gerald Rimbach
AU - Coby Annema
AU - Casper FM Franssen
AU - Stephan JL Bakker
AU - Adrian Post
PY - 2026
DA - 2026/09/25
JO - Current Developments in Nutrition
DO - 10.1016/j.cdnut.2026.109543
UR - https://doi.org/10.1016/j.cdnut.2026.109543
AB - Background: Low bromide intake may be a modifiable risk factor for reduced survival among kidney transplant recipients (KTRs). Objectives: We investigated dietary determinants of 24-h urinary bromide excretion and examined the association between 24-h urinary bromide excretion and mortality. Given potential sex differences, additional sex-stratified analyses were performed. Methods: Adult KTRs from the TransplantLines Food & Nutrition Biobank and Cohort Study were included. Dietary determinants of urinary bromide excretion were assessed with multivariable linear regression. Associations of 24-h urinary bromide excretion were evaluated using multivariable sex-stratified Cox regression analyses. Results: The study included 693 KTRs (43% female; mean age 53 ± 13 y). Urinary bromide excretion was lower in females than in males [median: 2958 (IQR: 2343–3713)] compared with median: 3640 [IQR: 2853–4585] μg/24 h; P < 0.001}. Energy intake (β = 0.12, P = 0.002), animal protein intake (β = 0.16, P = 0.001), and water intake (β = 0.13, P = 0.005) were positively associated with urinary bromide excretion. In sex-stratified analyses, animal protein intake was a significant determinant of bromide excretion in females (β = 0.22, P = 0.002), whereas water (β = 0.15, P = 0.02) and energy intake (β = 0.13, P = 0.01) were associated with bromide excretion in males. During a median follow-up of 5.3 (IQR: 4.8–6.1) years, 150 KTRs (21.6%) died. Higher urinary bromide excretion was consistently associated with a lower risk of mortality, even after adjustment for potential confounders [hazard ratio [HR]: 0.67 [95% confidence interval (CI): 0.50, 0.90]; P = 0.008]. The association of urinary bromide excretion with mortality was significantly modified by sex (Pinteraction = 0.02). Among females, there was a significant independent association between higher urinary bromide excretion and lower mortality [HR: 0.45 (95% CI: 0.29;0.72), P = 0.001], whereas no such association was observed in males. Conclusions: Energy, animal protein, and water intake were positively associated with urinary bromide excretion, with sex-specific differences. Lower urinary bromide excretion was independently associated with increased all-cause mortality in female, but not in male KTRs. These findings support further investigation into whether improving bromide status could reduce mortality, particularly among female KTRs. This trial was registered at clinicaltrials.gov as NCT02811835.
SN - 2475-2991
ER -