Abstract
Interest in the dietary treatment of chronic kidney disease has been growing as its incidence has been increasing. Chronic Kidney Disease (CKD) is now the 8th leading cause of death in the United States and its treatment consumes substantial amounts of medical resources and money. Several lines of epidemiological research have shown a lower risk of chronic kidney disease among vegetarians. It also shows a substantially increased risk among omnivores, especially those who eat red and processed meats. Although the practice started long ago, research on the use of a low-protein plant-based diet to treat chronic kidney disease diet has intensified in recent years. This research has shown that a low-protein vegetarian diet is safe and efficacious at both treating and slowing the progression of chronic kidney disease. Treatment with a low-protein vegetarian diet, often supplemented with keto analogues, has been shown to reduce acidosis, phosphotemia, uremia, proteinuria and to slow progression. Research shows that this treatment does not result in malnutrition. Research has also shown that larger amounts of plant protein than animal protein can be consumed, without deleterious effects. Treatment with a low protein vegetarian diet also has the advantage of preventing and treating common comorbidities such as type 2 diabetes and coronary artery disease.
Generated Summary
This review article discusses the growing interest in dietary treatment for chronic kidney disease (CKD) and emphasizes the benefits of a plant-based diet in preventing and treating this condition. The article highlights that CKD is a significant health concern with increasing incidence, leading to substantial medical resource utilization. The research approach involves reviewing epidemiological studies, intervention studies, and pathophysiological mechanisms to support the advantages of plant-based diets. The review focuses on the role of a low-protein, vegetarian diet, often supplemented with keto analogues, in managing CKD. It provides context about the benefits of the diet in slowing CKD progression, reducing various complications, and preventing common comorbidities. The review also compares the vegan diet with other diets. The article underscores the importance of dietary protein quality by substituting plant-sourced protein for animal-sourced protein. Finally, it explores the benefits of supplementing with ketoanalogues and the role of bacterial toxicology and the effects of persistent organic pollutants, or POPs, and their connection to CKD.
Key Findings & Statistics
- Chronic kidney disease (CKD) is now the 8th leading cause of death in the United States.
- Red and processed meat increased the risk of CKD by 23% (Q5:Q1), whereas a higher dietary intake (Q5:Q1) of nuts and legumes resulted in a 19% and 17% decreased risk respectively.
- Adults aged 45-74 years old, red meat intake was strongly associated with an increased risk of the eventual development of End Stage Renal Disease (ESRD) in previously healthy people in a dose-dependent manner, with the highest quartile having a 40% increased risk over the lowest.
- Replacing one serving of red meat with other food sources of protein was associated with a maximum relative risk reduction of 62.4%.
- Female participants in the Nurses’ Health Study who had followed a western dietary pattern (higher intake of red and processed meats, saturated fats, and sweets) had 2.17 times the risk of microalbuminuria.
- Vegans have been found to have a 75% decreased risk of hypertension and a 78% reduced risk of type II diabetes.
- In a study of adults aged 45-74 years old, red meat intake was strongly associated with an increased risk of the eventual development of End Stage Renal Disease (ESRD) in previously healthy people in a dose-dependent manner, with the highest quartile having a 40% increased risk over the lowest.
- Substituting soy and other legumes for red meat resulted in a reduced risk for ESRD by about 50%-62%.
- One study showed that vegans had a lower glomerular filtration rate (GFR) of 100 ml/min/1.73 m2, compared to 105 ml/min/1.73 m2 for vegetarians and 113 ml/min/1.73 m2 for omnivores.
- The vegan diet is associated with a 75% decreased risk of hypertension and a 78% reduced risk of type II diabetes.
- Red and processed meat increased the risk of CKD by 23% (Q5:Q1), while higher dietary intake (Q5:Q1) of nuts and legumes resulted in a 19% and 17% decreased risk, respectively.
- In a meta-study, healthy dietary patterns high in fruits, vegetables, legumes, and whole grains were consistently associated with lower mortality or ESRD among adults with CKD, with a risk reduction of 30%.
- Substituting soy and other legumes for red meat resulted in a reduced risk for ESRD by about 50%-62%.
- A study with 82 patients with type 1 diabetes with progressive diabetic nephropathy showed that a moderately low-protein diet (0.9 g/kg/day) reduced the risk of end-stage renal disease or death by 76%.
- In one study, a very low-protein diet (VLPD) reduced net endogenous acid production (NEAP) by 53% after six months and 67% after 12 months, and potential renal acid load (PRAL) by 120% after six months and 138% after 12 months.
- The fact that the acid load linked to animal proteins is higher than that linked to plant proteins is already known in the scientific community.
- In one study, a vegetarian diet resulted in a 62% lower average PCS excretion and 58% lower average IS excretion in vegetarians.
Other Important Findings
- The article indicates that a low-protein vegetarian diet is safe and effective for treating and slowing the progression of CKD, without causing malnutrition.
- The review states that the diet is beneficial in preventing and treating common comorbidities like type 2 diabetes and coronary artery disease.
- Epidemiological studies reveal that vegetarians have a lower risk of CKD than omnivores, particularly those consuming red and processed meats.
- The article emphasizes that consuming plant protein can be advantageous compared to animal protein.
- The plant-based diet is a safe and efficacious treatment that helps prevent and treat common comorbidities.
- Plant-based diets are associated with lower risk factors for CKD, such as type 2 diabetes and hypertension.
- Studies show that eating red meat increases the risk of CKD, while consuming tree nuts, legumes, fruits, and vegetables lowers it.
- The vegan diet is associated with beneficial glomerular and systemic hemodynamic changes.
- Studies show that the introduction of plant-derived protein in place of animal-derived protein improves metabolic acidosis, reduces kidney injury, and slows nephropathy progression.
- Fruits and vegetables can be used to treat CKD without producing hyperkalemia.
- The transition from a mixed animal-vegetable diet to a plant-based diet was associated with a decrease in GFR and proteinuria.
- A vegan diet is fully sufficient for a low-protein diet for CKD patients.
- Substituting non-nitrogen ketoanalogues allows patients to benefit from dietary protein while avoiding possible untoward effects of nitrogenous wastes.
- A study of stage 3 CKD patients showed an increase of bicarbonate levels by increasing the amount of fruits and vegetables in their diet.
- Recent studies suggest additional potential benefits of healthy eating on CKD progression, including increasing the amount of linoleic acid (n-6 PUFA) from vegetable oils and thus reducing the amount of saturated fat ingested.
- A study of stage 3 CKD patients showed an increase of bicarbonate levels by increasing the amount fruits and vegetables in their diet.
- The risk of hyperuricemia was higher for higher serum concentrations of organochlorine pesticides, PCDDs, and dioxin-like substances, raising the risk of uremia by 1.4, 1.3, and 2.4 respectively.
- The article indicates that a vegan diet, by reducing LP, total cholesterol, TG, and Lp(a), decreases the risk of cardiovascular disease and is worth being considered as an alternative effective therapeutic tool in patients with advanced CKD.
- In another study of CKD patients, Lp(a) concentrations increased with the progression of renal failure, and a significant correlation was observed with serum creatinine (sCr).
Limitations Noted in the Document
- The study mentions the challenge of adherence to dietary changes, especially over the long term, which could limit the effectiveness of the intervention.
- The review acknowledges the need for more individualized dietary approaches, as the optimal protein intake may vary depending on the individual’s condition and response.
- The article references several studies with varying methodologies, populations, and follow-up periods, which may limit the comparability and generalizability of the findings.
- The study acknowledges that while the plant-based diet is promising, it may not be suitable for all patients, and the need for personalized treatment strategies.
- The review doesn’t provide a detailed analysis of the long-term effects of the plant-based diet on CKD progression and overall mortality.
Conclusion
The review emphasizes that the plant-based diet, particularly a low-protein vegetarian diet, presents a promising approach to managing chronic kidney disease. The benefits of this dietary approach include slowing the progression of CKD, reducing uremic toxicity, and addressing metabolic disorders. The article also emphasizes the importance of protein quality, favoring plant-based sources over animal-based ones. Furthermore, it highlights the role of supplementation with ketoanalogues and the potential of non-digestible carbohydrates to improve outcomes. The study underscores the role of dietary intervention, which may be particularly relevant given the low adherence levels. The discussion also addresses the need for personalized dietary approaches. The plant-based diet is a beneficial prophylaxis, and dietary therapy must be deeply analyzed and nutritional prescription has to be focused not only on reduction of protein content but also on proteins’ quality. The review strongly suggests that the plant-based diet deserves a place in physicians’ treatment options for CKD, it reduces health care costs for both the patient and society. Low-protein plant-based diets do not result in malnutrition or hyperkalemia and are even safe in pregnancy.
IFFS Team Summary
- Chronic kidney disease is prevented due to decreased Diabetes type 2, hypertension, saturated fat, persistent organic pollutants, and acid load, lower cardiovascular disease
- Special mention of vegan diet regarding hypertension and diabetes reduction
- Mentions potential benefit for Polycystic kidneys
- addition of fruits and vegetables
- vegetable protein substitution for animal protein, particularly soy
- lower phosphate loads
- ketoanalogues can be added to plant diet – the body can turn these into essential amino acids allow for very low protein diets in advanced Kidney disease
- addition of fruits and vegetables
- vegetable protein substitution for animal protein, particularly soy
- lower phosphate loads
- ketoanalogues can be added to plant diet –
- the body can turn these into essential amino acids
- allow for very low protein diets in advanced Kidney disease
- the body can turn these into essential amino acids
- allow for very low protein diets in advanced Kidney disease
DOI
10.19080/JOJUN.2019.06.555687