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Review
. 2019 Nov 1;10(Suppl_4):S367-S379.
doi: 10.1093/advances/nmz011.

Diet and Chronic Kidney Disease

Holly Kramer  1   2
Affiliations
Review

Diet and Chronic Kidney Disease

Holly Kramer. Adv Nutr. .

Abstract

Kidney disease affects almost 15% of the US population, and prevalence is anticipated to grow as the population ages and the obesity epidemic continues due to Western dietary practices. The densely caloric Western diet, characterized by high animal protein and low fruit and vegetable content, has fueled the growth of chronic diseases, including chronic kidney disease. The glomerulus or filtering unit of the kidney is very susceptible to barotrauma, and diets high in animal protein impede the glomerulus' ability to protect itself from hemodynamic injury. High animal protein intake combined with low intake of fruits and vegetables also leads to a high net endogenous acid production requiring augmentation of ammonium excretion in order to prevent acidosis. This higher workload of the kidney to maintain a normal serum bicarbonate level may further exacerbate kidney disease progression. This article reviews the potential mechanisms whereby several key characteristics of the typical Western diet may impact kidney disease incidence and progression. Reducing animal protein intake and egg yolk and increasing intake of fruits and vegetables and fiber may prevent or delay end-stage renal disease, but few clinical trials have examined vegetarian diets for management of chronic kidney disease. More research is needed to determine optimal dietary patterns for the prevention of kidney disease and its progression.

Keywords: Western diet; acidosis; animal protein; chronic kidney disease; kidney; nutrition; obesity; plant protein; protein.

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Figures

FIGURE 1
FIGURE 1
Glomerulus in the healthy state (A) and a glomerulus in the setting of high animal protein intake (B). Note that the afferent arteriole is dilated in the setting of high animal protein intake, which impairs autoregulation. GFR, glomerular filtration rate.
FIGURE 2
FIGURE 2
Distribution of podocytes around a glomerular capillary wall in a glomerulus in a healthy state (A) and in the setting of glomerular hypertrophy (B). Note that in the setting of glomerular hypertrophy, the density of podocyte distribution is decreased while the capillary diameter is increased, which leads to heightened capillary wall tension.
FIGURE 3
FIGURE 3
Dietary sources of choline, phosphatidylcholine, and l-carnitine include red meat, cheese, and egg yolk. Choline, phosphatidylcholine, and l-carnitine are metabolized in the gut, leading to production of trimethylamine N-oxide and p-cresyl sulfate. These uremic toxins are excreted by the kidney, and in the setting of reduced kidney function, circulating levels may increase and contribute to atherosclerosis. CKD, chronic kidney disease.
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References

    1. Centers for Disease Control and Prevention. National Chronic Kidney Disease Fact Sheet, 2017[Internet]. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention; 2017. Available from: https://www.cdc.gov/kidneydisease/pdf/kidney_factsheet.pdf.
    1. United States Renal Data System. 2018 USRDS Annual Data Report: cardiovascular disease in patients with CKD [Internet] National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease. Bethesda (MD). 2018. Available from: https://www.usrds.org.
    1. United States Renal Data System. 2015 USRDS Annual Data Report: cardiovascular disease in patients with ESRD [Internet] National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease. Bethesda (MD).2018[cited 20 Oct, 2018]. Available from: https://www.usrds.org.
    1. Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008;73(1):19–33. - PubMed
    1. United States Renal Data System. 2017 USRDS Annual Data Report: end-stage renal disease (ESRD) in the United States. Chapter 1: incidence and prevalence, patient characteristics, and treatment modalities [Internet] National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease; Bethesda (MD) 2017[cited 1 May, 2018]. Available from: https://www.usrds.org.

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