Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease

Abstract

Chronic kidney disease affects ≈37 million adults in the US, and it is often undiagnosed due to a lack of apparent symptoms in early stages. Chronic kidney disease (CKD) interferes with the body’s physiological and biological mechanisms, such as fluid electrolyte and pH balance, blood pressure regulation, excretion of toxins and waste, vitamin D metabolism, and hormonal regulation. Many CKD patients are at risk of hyperkalemia, hyperphosphatemia, chronic metabolic acidosis, bone deterioration, blood pressure abnormalities, and edema. These risks may be minimized, and the disease’s progression may be slowed through careful monitoring of protein, phosphorus, potassium, sodium, and calcium, relieving symptoms experienced by CKD patients. In this review, the current Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations are highlighted, reflecting the 2020 update, including explanations for the pathophysiology behind the recommendations. The Dietary Approaches to Stop Hypertension, the Mediterranean diet, and the whole foods plant-based diet are currently being examined for their potential role in delaying CKD progression. Biological explanations for why the whole foods plant-based diet may benefit CKD patients compared to diets that include animal products are examined. Strong evidence continues to support the importance of diet meeting the daily requirement in the prevention and progression of kidney disease, and medical nutrition therapy with a registered dietitian is a critical aspect in medical intervention for CKD.

Demographic and clinical profile of black patients with chronic kidney disease attending Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa

“…The prevalence of metabolic acidosis was 62.4 % in advanced CKD and 46.6 % in early CKD; this prevalence is higher than the 33% -40% among patients with CKD stage 3 -4 from other continents (14,40,41). The possible explanation could be firstly, the more rapid CKD progression which has been shown to occur in black patients even early in their CKD stages (16,28) and secondly, diet where replacement of traditional diets with contemporary/ western foods which contain mainly animal proteins, less vegetables and low intake of fruits might increase CKD patients' dietary acid load (29,(42)(43)(44)(45). Patients with low serum bicarbonate levels were 2-fold more likely to have advanced CKD, as reported also in other studies (14,15).…”

Unraveling the Metabolic Hallmarks for the Optimization of Protein Intake in Pre-Dialysis Chronic Kidney Disease Patients

“…Phosphate plays a critical role in bone formation, acid-base balance, and energy production, and its homeostasis is achieved by excreting the excess phosphate in the urine. However, the decrease in renal function that occurs for CKD patients prevents the maintenance of this homeostasis, with it being necessary to rigorously control phosphate intake [ 2 ]. To avoid related problems with kidney malfunction, the 2020 KDOQI-NKF guidelines recommended an intake of phosphate that keeps serum phosphate levels within normal ranges (3.4–4.5 mg/dL), paying special attention to the dietary phosphate for the case of hyperphosphatemia [ 2 , 17 ].…”

“…However, the decrease in renal function that occurs for CKD patients prevents the maintenance of this homeostasis, with it being necessary to rigorously control phosphate intake [ 2 ]. To avoid related problems with kidney malfunction, the 2020 KDOQI-NKF guidelines recommended an intake of phosphate that keeps serum phosphate levels within normal ranges (3.4–4.5 mg/dL), paying special attention to the dietary phosphate for the case of hyperphosphatemia [ 2 , 17 ]. As the bioavailability of phosphate depends on dietary sources (i.e., 20–40% for plant foods; 40–60% for animal protein; and 100% for phosphate found in additives and processed foods), choosing phosphate-containing foods lower in phosphate bioavailability is recommended [ 2 ].…”

“…In this context, the Kidney Disease Quality Initiative-National Kidney Foundation (KDOQI-NKF) guidelines for nutrition recommends a protein intake of 0.6 to 0.8 g/kg/day for pre-dialysis patients with CKD with an energy intake of 30 kcal/kg/day. On the other hand, the amount of protein recommended for advanced CKD patients is higher than 0.8 g/kg/day (up to 1.0–1.2) to compensate for the increased loss of protein and amino acids during dialysis [ 1 , 2 ]. The degree of albuminuria is also a key factor when adjusting the daily amount of protein.…”

Mediterranean Diet Adherence and Nutritional Status in Dalmatian Diabetic Hypertensive Patients Regarding Presence of Chronic Kidney Disease—Is There Any Difference?

“…Nutritional interventions can slow the progression of the CKD in the earliest stages [ 12 ] but also delay the need for renal replacement therapy in later stages by carefully managing protein, potassium, phosphorus, sodium, and calcium intake [ 13 ]. Recommended intake of proteins according to the principles of the MeDi, which includes legumes, fish, and white meat, is in line with recommendations on protein intake for diabetic patients with CKD [ 14 ].…”