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Review
. 2025 Jun 14;17(12):2002.
doi: 10.3390/nu17122002.

Dos and Don'ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease

Massimo Torreggiani  1 , Carla Maria Avesani  2 , Barbara Contzen  3 , Adamasco Cupisti  4 , Sylwia Czaja-Stolc  5 , Claudia D'Alessandro  4 , Liliana Garneata  6 , Abril Gutiérrez  7 , Françoise Lippi  1 , Carmen Antonia Mocanu  6 , Alice Sabatino  2 , Giorgina Barbara Piccoli  1 ; European Renal Nutrition (ERN) Working Group of the European Renal Association (ERA)
Affiliations
Review

Dos and Don'ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease

Massimo Torreggiani et al. Nutrients. .

Abstract

Dietary management is a pillar of chronic kidney disease (CKD) treatment. While some rules are the same as dietary prescriptions for the general population and those suffering from other chronic diseases (energy intake, salt intake, avoidance of ultra-processed food and limited intake of animal fats), in non-dialysis-dependent patients living with CKD, the specific focus is on protein intake. Low-protein diets (LPDs) and supplemented very low protein diets (sVLPDs) have been successfully employed to decrease the symptoms of people living with non-dialysis-dependent CKD, delay the progression of the disease and retard the need for dialysis. Randomized clinical trials have yielded conflicting results on efficacy, resulting in conflicting guidelines. Concerns about the risk of malnutrition (specifically when the main source of proteins is plant-derived), electrolyte imbalances, and energy intake, and the idea that adherence is difficult, jeopardize the use and wide application of LPDs and sVLPDs. That dietary management focuses mainly on nutrients while dietary quality occupies second place is also an erroneous concept that requires discussion. In September 2023, a group of experts composed of nephrologists and dieticians gathered in Frankfurt, Germany, to try to reconcile the different guideline indications and address most of the common doubts of final dispatchers to increase the prescription of "renal diets" and improve people living with CKD's adherence to them.

Keywords: education; elderly patients; ketoanalogues; low-protein diets; protein intake; ultra-processed food.

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Conflict of interest statement

The meeting on which the current paper is based was funded by Fresenius Kabi; authors received hospitality and transportation expenses and a consultancy fee. Fresenius Kabi had no role in the discussion or in the writing and editing of this manuscript.

Figures

Figure 1
Figure 1
Balancing study designs in nutritional management of CKD: (A) randomized clinical trials (RCT); (B) observational studies.
Figure 2
Figure 2
Calculating ideal body weight according to different formulas. Ideal weight calculator, available at https://www.calculator.net/ideal-weight-calculator.html.
Figure 3
Figure 3
CT scan for the diagnosis of sarcopenic obesity. Legend: in addition to being used as traditional diagnostic tests, CT scans performed for other reasons provide valuable insights into the muscle mass of people living with CKD [81,82,83]. Free software exists to help interpret cross-sectional CT images, usually at the third lumbar vertebra (L3), or at the iliac crest, which can provide reliable estimates of body composition [84]. Notably, in the panel on the right, the quality and not only the quantity of muscle is impaired.
Figure 4
Figure 4
Balancing age and chronic kidney disease (CKD) (adapted from [101]).
Figure 5
Figure 5
An example of a plant-based drink with high-energy and low-protein content.
Figure 6
Figure 6
A recipe for a high-energy density snack with low-protein content.
Figure 7
Figure 7
Cognitive and behavioral approaches in dietary education (adapted from [136]).
See this image and copyright information in PMC

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