Abstract
Chronic kidney disease (CKD) affects >10% of the adult population. Each year, approximately 120,000 Americans develop end-stage kidney disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates, exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6–0.8 g/kg/day composed of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, is promising and consistent with the precision nutrition. The scientific premise of the PLADO stems from the observations that high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of constipation with resulting hyperkalemia from the typical low fiber intake. A plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.
Highlights
Other important studies supporting the benefit of a plant-dominant diet in slowing Chronic kidney disease (CKD) progression include the study by Lin et al [63], Kim et al [64], Haring et al
The successful implementation of plant-based restricted protein diets is dependent on the engagement of dietitians who are well trained in the field of non-dialysis CKD [120]
Summary
Chronic kidney disease (CKD) has no cure and affects more than 10% of the adult population throughout the world [1]. The World Kidney Day steering committee declared 2020 and 2021 as the years of CKD prevention and living well with CKD, respectively These declarations underscore the paramount importance of both primary CKD prevention as well as secondary and tertiary interventions for early diagnosis of CKD and treatment to control progression to ESKD and its complications, respectively [1,11]. U.S President, known as the “Advancing American Kidney Health Initiative,” sought to reduce the number of Americans developing kidney failure by 25% by 2030 through improved efforts to slow the progression of CKD [12]. This timely executive order underscores the importance of preventive. This review article highlights past and contemporary data on the dietary management of CKD with focus on the role of plant-based, restricted protein diets based on the premise that feasible dietary approaches should be the cornerstone of non-pharmacologic strategies in slowing CKD progression and avoiding or delaying ESKD [13]
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