Vegetarian Nutrition in Chronic Kidney Disease

Abstract

There is rising interest globally with respect to the health implications of vegetarian or plant-based diets. A growing body of evidence has demonstrated that higher consumption of plant-based foods and the nutrients found in vegetarian and plant-based diets are associated with numerous health benefits, including improved blood pressure, glycemic control, lipid levels, body mass index, and acid-base parameters. Furthermore, there has been increasing recognition that vegetarian and plant-based diets may have potential salutary benefits in preventing the development and progression of chronic kidney disease (CKD). While increasing evidence shows that vegetarian and plant-based diets have nephroprotective effects, there remains some degree of uncertainty about their nutritional adequacy and safety in CKD (with respect to protein-energy wasting, hyperkalemia, etc.). In this review, we focus on the potential roles of and existing data on the efficacy/effectiveness and safety of various vegetarian and plant-based diets in CKD, as well as their practical application in CKD management.

Keywords: chronic kidney disease; nutrition; plant-based diet; vegetarian diet.

Figure 1

Characteristics of nutrients and components in plant-based vs. animal-based diets. Abbreviations: ALA, α-linolenic acid; B1, vitamin B1; B6, vitamin B6; B12, vitamin B12, Ca, calcium; D, vitamin D; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; Fe, iron; K, potassium; Mg, magnesium; MUFAs, monounsaturated fatty acids; phytochem, phytochemicals; Pi, phosphorus; PUFAs, total polyunsaturated fatty acids; SFAs, saturated fatty acids; Zn, zinc.

Figure 2

Plant-based diets and health benefits in chronic kidney disease. Abbreviations: ALA, α-linolenic acid; CKD, chronic kidney disease; CVD, cardiovascular disease; ESKD, end-stage kidney disease; MUFAs, monounsaturated fatty acids; PUFAs, total polyunsaturated fatty acids; SFAs, saturated fatty acids.

Figure 3

Potential mechanisms contributing to the lower bioavailability of potassium from plant-based foods. Abbreviations: K, potassium.

Figure 4

Potential dietary factors related to the risk of hyperkalemia. Lower absolute dietary potassium intake and/or having a diet with lower potassium bioavailability following consumption of healthy plant-based diets composed of unprocessed plant-based foods could result in a reduced risk of hyperkalemia. On the other hand, higher absolute dietary potassium intake and/or having a diet with higher potassium bioavailability following consumption of animal-based foods and processed foods could result in increased risk of hyperkalemia. Abbreviations: K, potassium.