Adherence to a Healthy Plant-Based Diet and Cardiovascular-Kidney-Metabolic Risk Factors in Patients with Moderate to Advanced Chronic Kidney Disease

Abstract

Objective: The confluence of cardiovascular-kidney-metabolic (CKM) risk factors and chronic kidney disease (CKD) elevates the risk for adverse cardiovascular and kidney outcomes. Mounting evidence has emerged on the benefits of plant-based diets for CKD management. However, whether the benefits are mediated by improved CKM health are unclear. In addition, there remain concerns about the risk of malnutrition and hyperkalemia associated with plant-based diets. The objective of this study was to assess the relationship between adherence to healthy plant-based diets and CKM syndrome, nutritional status, and serum potassium levels in patients with nondialysis CKD stages 3-5.

Method: A total of 147 patients (median age 66 years) with CKD (median eGFR 23.1 mL/min/1.73 m²) were included. Responses to a food frequency questionnaire developed for the Asian population with CKD were used to calculate a healthy plant-based diet score (HPDS), which reflects higher consumption of plant foods and reduced intake of animal products and sugar. CKM risk factors included overweight/obesity, central obesity, high blood pressure, high triglycerides, and high blood glucose. Nutritional status was assessed using serum albumin and dietary energy and protein intake.

Results: In logistic regression analyses, a higher HPDS was significantly associated with lower odds of all CKM risk factors and malnutrition. After adjusting for age, sex, comorbidities, lifestyle factors, and medications, a higher HPDS remained significantly linked to lower odds of overweight/obesity and central obesity, as well as higher odds of having a normal serum albumin level (≥ 3.8 g/dL), dietary protein intake (≥ 0.6 g/kg/day), and dietary energy intake (≥ 25 g/kg/day). No significant association was observed between HPDS and hyperkalemia.

Conclusions: In patients with moderate to advanced CKD, healthy plant-based diets were associated with a lower risk of CKM syndrome. Adherence to a healthy plant-based diet was more likely to achieve a better nutritional status and was not associated with risk of hyperkalemia.

Keywords: Cardiovascular-kidney-metabolic syndrome; hyperkalemia; malnutrition; obesity; plant-based diet.