Abstract
Nutrition is a cornerstone in the management of chronic kidney disease (CKD). To limit urea generation and accumulation, a global reduction in protein intake is routinely proposed. However, recent evidence has accumulated on the benefits of plant-based diets and plant-derived proteins without a clear understanding of underlying mechanisms. Particularly the roles of some amino acids (AAs) appear to be either deleterious or beneficial on the progression of CKD and its complications. This review outlines recent data on the role of a low protein intake, the plant nature of proteins, and some specific AAs actions on kidney function and metabolic disorders. We will focus on renal hemodynamics, intestinal microbiota, and the production of uremic toxins. Overall, these mechanistic effects are still poorly understood but deserve special attention to understand why low-protein diets provide clinical benefits and to find potential new therapeutic targets in CKD.
Highlights
Chronic kidney disease (CKD) affects nearly 800 million people worldwide
The KLF15 downregulation and renal fibrosis are reversed with dietary protein restriction in mice. These results suggest that KLF15 may play a role in suppressing renal fibrosis and could contribute to the benefits reported during dietary protein restriction and branched-chain amino acids (BCAAs) restriction
We showed in a preliminary work that a specific restriction in aromatic amino acids (AAs) intake in CKD mice mitigated inflammation that plays a major role in the progression of renal damage [98]
Summary
Chronic kidney disease (CKD) affects nearly 800 million people worldwide. The kidney has a major role in nutritional homeostasis and partly regulates the amino acids (AAs) pool via their synthesis and degradation. In the context of CKD, another recent meta-analysis of cohort studies linked the daily consumption of plant-based diets and plant proteins with a lower risk of CKD prevalence, incidence, and estimated glomerular filtration rate (eGFR) decline over time [18,19]. The new international guidelines of the Kidney Disease Outcomes Quality Initiative (KDOQI) did not recommend plant protein over animal protein in CKD due to lack of evidence and because overall data strength was found to be low They do recommend a plant-based pattern in CKD patients for its potential benefits on body weight, blood pressure, and net acid production but not for renal protection [6]
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