Nutrition in Chronic Kidney Disease: Nephrology Dialysis Transplantation Notable Advances in 2018

Philippe Chauveau


Nephrol Dial Transplant. 2019;34(6):893-896. 

In This Article

Healthy Diet and Vegetarian Diet in CKD

An increase in plant-based diets is now recommended for the general population. Dietary patterns, including the dietary approaches to stop hypertension diet or Mediterranean diet, which are higher in fibre and fruit contents and low in salt and processed meat, are associated with a lower risk for cardiovascular disease and hypertension.[4] For a long time, a restricted diet of fruits and vegetables has been proposed to CKD patients because of fear of hyperkalaemia. Vegetarian or Mediterranean diets are rich in alkaline food. Better control of acidosis is associated with less progression of CKD and promotes intracellular distribution of potassium. The benefits of plant-based diets were reviewed in two papers in NDT in 2018: one from the European Renal Working Group of EDTA (ERN-EDTA) about the Mediterranean diet and one about vegetarian diets in CKD patients.[5,6] The Mediterranean diet has been associated with reduced cardiovascular disease and is close to the actual recommendations for CKD patients: controlled protein diet, low red meat intake, low sodium intake, rich in fruits and vegetables, and increased content of olive oil. This dietary pattern reduces inflammation and oxidative stress. Higher adherence to a Mediterranean diet is associated with a decrease in incident CKD, but not in all cohort studies.[7,8] In addition, a diet rich in fibre by its action on the intestinal microbiota reduces the production and absorption of uraemic toxins.[9] A high-fibre diet reduces the inflammatory status of CKD patients. Hyperphosphataemia is observed at later stages of CKD, but a high phosphate load at early stages induces increased levels of fibroblast growth factor-23 (FGF-23) and cardiovascular complications. On one hand, phosphate absorption is lower in vegetarian diets; on the other hand, lower consumption of processed food is associated with a lower intake of hidden phosphate. All the hypothesized effects of a vegetarian diet are summarized in Figure 1, from Chauveau et al..[6]

Figure 1.

Hypothesized effects of a vegetarian diet and its components on CKD. AGEs, advanced glycation end-products; FGF23, fibroblast growth factor 23; IS, indoxyl sulphate; LPS, lipopolysaccharide; PCS, p-cresyl sulphate; P/S ratio FA, polyunsaturated/saturated ratio of fatty acids; TMAO, trimethylamine-N-oxide. From Chauveau et al. [6].