Plant-based diets to manage the risks and complications of chronic kidney disease

Abstract

Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.

Source and Composition in Amino Acid of Dietary Proteins in the Primary Prevention and Treatment of CKD

“…Although plant and animal proteins differ in their AAs profiles, digestibility, and availability [11], these differences do not seem to be clinically relevant for the healthy adult general population with a varied and sufficient diet [88]. Indeed, the plasma AAs profile and in particular EAAs [89,90] of plant-based diets and animal-based diets is almost the same, except for a lower lysine-to-arginine ratio [91].…”

“…There is extensive literature on the benefits of plant-diet in CKD progression and complications [11,12,18]. Based on these studies, we have summarized on Figure 1 the mechanisms of plant-based diets on CKD progression.…”

“…Another important question related to plant-based diets is the high potassium content for some of them [11] and the potential risk of hyperkalemia in CKD patients. A recent international recommendation indicates a lack of robust studies assessing potassium intake requirements in CKD patients [6].…”

“…Therefore, recent studies have focused on the quality and diversity of proteins more than on quantity for the prevention and management of CKD. In addition, the increasing consumption of plant foods and vegan/vegetarian diets has remotivated the scientific community to identify its impact on health in the context of CKD [11,12]. In the present article, we review the recent evidence suggesting that the source of proteins (animal versus plant) and composition of AAs specifically affect CKD progression and complications.…”

Influence of Plant and Animal Proteins on Inflammation Markers among Adults with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…On the other hand, studies have shown that adults who consumed more plant protein (PP) or plant-based diets such as Mediterranean, Dietary Approaches to Stopping Hypertension (DASH), or vegetarian, resulted in reduction of weight, glycated hemoglobin (HbA1C), low-density and high-density lipoproteins and total cholesterol and lower inflammation markers among adults with various chronic diseases [ 32 , 33 ]. Further studies have demonstrated that through the consumption of PP or plant-based foods there is a reduction in the incidence of CKD [ 34 ], inflammation markers (IL-6 and CRP) [ 35 ], uremic toxins, all-cause mortality, and hospitalization among the CKD population [ 20 , 36 ]. The potential mechanism of action is that, as the intake of plants is increased, and if possible as the sole source of energy and protein, the net dietary acid load is lowered.…”