Dietary sodium restriction reduces proteinuria and lowers blood pressure in patients with chronic kidney disease (CKD); however, an effect on hard clinical outcomes remains to be established
Dietary sodium restriction to <2.3 g daily is suggested for patients with CKD
Diets rich in certain fruits and vegetables should be considered to ameliorate metabolic abnormalities in patients with CKD and potentially delay its progression
Moderate alcohol consumption (≤2 beverages or <20 g daily) has no proven beneficial or adverse effects in patients with CKD
Daily fluid intake to generate a daily urine output of >3 l might be considered in patients with CKD, especially those with polycystic kidney disease or recurrent kidney stones
Randomized controlled trials are needed to ascertain the optimum dietary recommendations for patients with CKD
Traditional strategies for management of patients with chronic kidney disease (CKD) have not resulted in any change in the growing prevalence of CKD worldwide. A historic belief that eating healthily might ameliorate kidney disease still holds credibility in the 21st century. Dietary sodium restriction to <2.3 g daily, a diet rich in fruits and vegetables and increased water consumption corresponding to a urine output of 3–4 l daily might slow the progression of early CKD, polycystic kidney disease or recurrent kidney stones. Current evidence suggests that a reduction in dietary net acid load could be beneficial in patients with CKD, but the supremacy of any particular diet has yet to be established. More trials of dietary interventions are needed, especially in diabetic nephropathy, before evidence-based recommendations can be made. In the meantime, nephrologists should discuss healthy dietary habits with their patients and provide individualized care aimed at maximizing the potential benefits of dietary intervention, reducing the incidence of CKD and delaying its progression to end-stage renal disease. Keeping in mind the lack of data on hard outcomes, dietary recommendations should take into account barriers to adherence and be tailored to different cultures, ethnicities and geographical locations.
Subscribe to Journal
Get full journal access for 1 year
only $4.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Menon, V. et al. Long-term outcomes in nondiabetic chronic kidney disease. Kidney Int. 73, 1310–1315 (2008).
Alves, T. P. et al. Rate of ESRD exceeds mortality among African Americans with hypertensive nephrosclerosis. J. Am. Soc. Nephrol. 21, 1361–1369 (2010).
Kasiske, B. L. et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 77, 299–311 (2010).
Curhan, G. C. & Mitch, W. E. in Brenner and Rector's The Kidney 8th edn Ch. 53 (eds Taal, M. W. et al.) 1817–1847 (Elsevier, 2006).
Goraya, N. & Wesson, D. E. Dietary management of chronic kidney disease: protein restriction and beyond. Curr. Opin. Nephrol. Hypertens. 21, 635–640 (2012).
Peterson, J. C. et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann. Intern. Med. 123, 754–762 (1995).
Obarzanek, E. et al. Individual blood pressure responses to changes in salt intake: results from the DASH-Sodium trial. Hypertension 42, 459–467 (2003).
Sacks, F. M. et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N. Engl. J. Med. 344, 3–10 (2001).
Bakris, G. L. & Weir, M. R. Salt intake and reductions in arterial pressure and proteinuria. Is there a direct link? Am. J. Hypertens. 9, 200S–206S (1996).
Heeg, J. E., de Jong, P. E., van der Hem, G. K. & de Zeeuw, D. Efficacy and variability of the antiproteinuric effect of ACE inhibition by lisinopril. Kidney Int. 36, 272–279 (1989).
Weir, M. R. The influence of dietary salt on the antiproteinuric effect of calcium channel blockers. Am. J. Kidney. Dis. 29, 800–805 (1997).
Wheeler, D. C. & Becker, G. J. Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease? Kidney Int. 83, 377–383 (2013).
Taler, S. J. et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. Am. J. Kidney Dis. 62, 201–213 (2013).
Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am. J. Kidney Dis. 43, S1–S290 (2004).
Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. Suppl. 2, 337–414 (2012).
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans [online], (2010).
Committee on the Consequences of Sodium Reduction in Populations (Eds) Sodium Intake in Populations: Assessment of Evidence (The National Academies Press, 2013).
Vegter, S. et al. Sodium intake, ACE inhibition, and progression to ESRD. J. Am. Soc. Nephrol. 23, 165–173 (2012).
Thomas, M. C. et al. The association between dietary sodium intake, ESRD, and all-cause mortality in patients with type 1 diabetes. Diabetes Care 34, 861–866 (2011).
Dunkler, D. et al. Diet and kidney disease in high-risk individuals with type 2 diabetes mellitus. JAMA Intern. Med. 173, 1682–1692 (2013).
Ohta, Y., Tsuchihashi, T., Kiyohara, K. & Oniki, H. High salt intake promotes a decline in renal function in hypertensive patients: a 10-year observational study. Hypertens. Res. 36, 172–176 (2013).
Cohen, H. W., Hailpern, S. M., Fang, J. & Alderman, M. H. Sodium intake and mortality in the NHANES II follow-up study. Am. J. Med. 119, 275.e7–275.e14 (2006).
O'Donnell, M. J. et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA 306, 2229–2238 (2011).
Brunner, H. R. et al. Essential hypertension: renin and aldosterone, heart attack and stroke. N. Engl. J. Med. 286, 441–449 (1972).
Sever, P. S. et al. Is plasma renin activity a biomarker for the prediction of renal and cardiovascular outcomes in treated hypertensive patients? Observations from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Eur. Heart J. 33, 2970–2979 (2012).
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 288, 2981–2997 (2002).
Welch, J. L., Bennett, S. J., Delp, R. L. & Agarwal, R. Benefits of and barriers to dietary sodium adherence. West. J. Nurs. Res. 28, 162–180 (2006).
Pivert, K. The IOM on salt—is too little same as the too much? ASN Kidney News [online], (2013).
Maillot, M., Monsivais, P. & Drewnowski, A. Food pattern modeling shows that the 2010 dietary guidelines for sodium and potassium cannot be met simultaneously. Nutr. Res. 33, 188–194 (2013).
de Brito-Ashurst, I. et al. The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: a randomised controlled trial. Heart 99, 1256–1260 (2013).
Yu, W., Luying, S., Haiyan, W. & Xiaomei, L. Importance and benefits of dietary sodium restriction in the management of chronic kidney disease patients: experience from a single Chinese center. Int. Urol. Nephrol. 44, 549–556 (2012).
Slagman, M. C. et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial. BMJ 343, d4366 (2011).
McMahon, E. J. et al. A randomized trial of dietary sodium restriction in CKD. J. Am. Soc. Nephrol. 24, 2096–2103 (2013).
Bellizzi, V. et al. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int. 71, 245–251 (2007).
Barsotti, G. et al. A low-nitrogen low-phosphorus vegan diet for patients with chronic renal failure. Nephron 74, 390–394 (1996).
Dunford, E. et al. The variability of reported salt levels in fast foods across six countries: opportunities for salt reduction. CMAJ 184, 1023–1028 (2012).
Alderman, M. H. Reducing dietary sodium: the case for caution. JAMA 303, 448–449 (2010).
Gutierrez, O. M. Sodium- and phosphorus-based food additives: persistent but surmountable hurdles in the management of nutrition in chronic kidney disease. Adv. Chronic Kidney Dis. 20, 150–156 (2013).
Anderson, C. A. et al. Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. J. Am. Diet. Assoc. 110, 736–745 (2010).
McMahon, E. J., Campbell, K. L., Mudge, D. W. & Bauer, J. D. Achieving salt restriction in chronic kidney disease. Int. J. Nephrol. 2012, 720429 (2012).
Jacobson, M. F., Havas, S. & McCarter, R. Changes in sodium levels in processed and restaurant foods, 2005 to 2011. JAMA Intern. Med. 173, 1285–1291 (2013).
Hostetter, T. H., Meyer, T. W., Rennke, H. G. & Brenner, B. M. Chronic effects of dietary protein in the rat with intact and reduced renal mass. Kidney Int. 30, 509–517 (1986).
Tucker, S. M., Mason, R. L. & Beauchene, R. E. Influence of diet and feed restriction on kidney function of aging male rats. J. Geront. 31, 264–270 (1976).
D'Amico, G. & Gentile, M. G. Effect of dietary manipulation on the lipid abnormalities and urinary protein loss in nephrotic patients. Miner. Electrolyte. Metab. 18, 203–206 (1992).
D'Amico, G. et al. Effect of vegetarian soy diet on hyperlipidaemia in nephrotic syndrome. Lancet 339, 1131–1134 (1992).
Jibani, M. M., Bloodworth, L. L., Foden, E., Griffiths, K. D. & Galpin, O. P. Predominantly vegetarian diet in patients with incipient and early clinical diabetic nephropathy: effects on albumin excretion rate and nutritional status. Diabet. Med. 8, 949–953 (1991).
Kontessis, P. A. et al. Renal, metabolic, and hormonal responses to proteins of different origin in normotensive, nonproteinuric type I diabetic patients. Diabetes Care 18, 1233 (1995).
Tovar-Palacio, C. et al. Proinflammatory gene expression and renal lipogenesis are modulated by dietary protein content in obese Zucker fa/fa rats. Am. J. Physiol. Renal Physiol. 300, F263–F271 (2011).
Remer, T. Influence of diet on acid-base balance. Semin. Dial. 13, 221–226 (2000).
Lennon, E. J., Lemann, J. Jr & Litzow, J. R. The effects of diet and stool composition on the net external acid balance of normal subjects. J. Clin. Invest. 45, 1601–1607 (1966).
Frassetto, L. A., Todd, K. M., Morris, R. C. Jr & Sebastian, A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am. J. Clin. Nutr. 68, 576–583 (1998).
Nath, K. A., Hostetter, M. K. & Hostetter, T. H. Pathophysiology of chronic tubulo-interstitial disease in rats. Interactions of dietary acid load, ammonia, and complement component C3. J. Clin. Invest. 76, 667–675 (1985).
Wesson, D. E., Simoni, J. & Prabhakar, S. Endothelin-induced increased nitric oxide mediates augmented distal nephron acidification as a result of dietary protein. J. Am. Soc. Nephrol. 17, 406–413 (2006).
Khanna, A., Simoni, J., Hacker, C., Duran, M. J. & Wesson, D. E. Increased endothelin activity mediates augmented distal nephron acidification induced by dietary protein. J. Am. Soc. Nephrol. 15, 2266–2275 (2004).
Wesson, D. E. Endogenous endothelins mediate increased distal tubule acidification induced by dietary acid in rats. J. Clin. Invest. 99, 2203–2211 (1997).
Wesson, D. E. Dietary bicarbonate reduces rat distal nephron acidification evaluated in situ. Am. J. Physiol. 258, F870–F876 (1990).
Wesson, D. E. & Simoni, J. Acid retention during kidney failure induces endothelin and aldosterone production which lead to progressive GFR decline, a situation ameliorated by alkali diet. Kidney Int. 78, 1128–1135 (2010).
Phisitkul, S. et al. Amelioration of metabolic acidosis in patients with low GFR reduced kidney endothelin production and kidney injury, and better preserved GFR. Kidney Int. 77, 617–623 (2010).
Mahajan, A. et al. Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy. Kidney Int. 78, 303–309 (2010).
Chang, A. et al. Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am. J. Kidney Dis. 62, 267–275 (2013).
Nettleton, J. A., Steffen, L. M., Palmas, W., Burke, G. L. & Jacobs, D. R. Jr. Associations between microalbuminuria and animal foods, plant foods, and dietary patterns in the Multiethnic Study of Atherosclerosis. Am. J. Clin. Nutr. 87, 1825–1836 (2008).
Lin, J., Fung, T. T., Hu, F. B. & Curhan, G. C. Association of dietary patterns with albuminuria and kidney function decline in older white women: a subgroup analysis from the Nurses' Health Study. Am. J. Kidney Dis. 57, 245–254 (2011).
Scialla, J. J. et al. Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. Clin. J. Am. Soc. Nephrol. 6, 1526–1532 (2011).
Diaz-Lopez, A. et al. Effects of Mediterranean diets on kidney function: a report from the PREDIMED trial. Am. J. Kidney Dis. 60, 380–389 (2012).
Jain, N. & Reilly, R. F. Risk factors: filling in the gap. Nat. Rev. Nephrol. 8, 562–563 (2012).
de Brito-Ashurst, I., Varagunam, M., Raftery, M. J. & Yaqoob, M. M. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J. Am. Soc. Nephrol. 20, 2075–2084 (2009).
Goraya, N., Simoni, J., Jo, C. & Wesson, D. E. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney Int. 81, 86–93 (2012).
Goraya, N., Simoni, J., Jo, C. H. & Wesson, D. E. A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clin. J. Am. Soc. Nephrol. 8, 371–381 (2013).
Pearson, T. A. Alcohol and heart disease. Circulation 94, 3023–3025 (1996).
Krauss, R. M. et al. Dietary guidelines for healthy American adults. A statement for health professionals from the Nutrition Committee, American Heart Association. Circulation 94, 1795–1800 (1996).
Perneger, T. V., Whelton, P. K., Puddey, I. B. & Klag, M. J. Risk of end-stage renal disease associated with alcohol consumption. Am. J. Epidemiol. 150, 1275–1281 (1999).
Funakoshi, Y. et al. Association between frequency of drinking alcohol and chronic kidney disease in men. Environ. Health Prev. Med. 17, 199–204 (2012).
Hsu, Y. H., Pai, H. C., Chang, Y. M., Liu, W. H. & Hsu, C. C. Alcohol consumption is inversely associated with stage 3 chronic kidney disease in middle-aged Taiwanese men. BMC Nephrol. 14, 254 (2013).
Shankar, A., Klein, R. & Klein, B. E. The association among smoking, heavy drinking, and chronic kidney disease. Am. J. Epidemiol. 164, 263–271 (2006).
Knight, E. L., Stampfer, M. J., Rimm, E. B., Hankinson, S. E. & Curhan, G. C. Moderate alcohol intake and renal function decline in women: a prospective study. Nephrol. Dial. Transplant. 18, 1549–1554 (2003).
White, S. L. et al. Alcohol consumption and 5-year onset of chronic kidney disease: the AusDiab study. Nephrol. Dial. Transplant. 24, 2464–2472 (2009).
Yamagata, K. et al. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney Int. 71, 159–166 (2007).
Wakasugi, M., Kazama, J. J., Yamamoto, S., Kawamura, K. & Narita, I. A combination of healthy lifestyle factors is associated with a decreased incidence of chronic kidney disease: a population-based cohort study. Hypertens. Res. 36, 328–333 (2013).
Schaeffner, E. S. et al. Alcohol consumption and the risk of renal dysfunction in apparently healthy men. Arch. Intern. Med. 165, 1048–1053 (2005).
Reynolds, K. et al. Alcohol consumption and the risk of end-stage renal disease among Chinese men. Kidney Int. 73, 870–876 (2008).
Nishank, J. & Susan Hedayati, S. Rise or fall of glomerular filtration rate: does it matter? Kidney Int. 83, 550–553 (2013).
Chung, F. M. et al. Effect of alcohol consumption on estimated glomerular filtration rate and creatinine clearance rate. Nephrol. Dial. Transplant. 20, 1610–1616 (2005).
Amore, A. et al. Experimental IgA nephropathy secondary to hepatocellular injury induced by dietary deficiencies and heavy alcohol intake. Lab. Invest. 70, 68–77 (1994).
Bouby, N., Bachmann, S., Bichet, D. & Bankir, L. Effect of water intake on the progression of chronic renal failure in the 5/6 nephrectomized rat. Am. J. Physiol. 258, F973–F979 (1990).
Sugiura, T. et al. High water intake ameliorates tubulointerstitial injury in rats with subtotal nephrectomy: possible role of TGF-β. Kidney Int. 55, 1800–1810 (1999).
Anastasio, P. et al. Level of hydration and renal function in healthy humans. Kidney Int. 60, 748–756 (2001).
Hadj-Aissa, A. et al. Influence of the level of hydration on the renal response to a protein meal. Kidney Int. 42, 1207–1216 (1992).
Nagao, S. et al. Increased water intake decreases progression of polycystic kidney disease in the PCK rat. J. Am. Soc. Nephrol. 17, 2220–2227 (2006).
Borghi, L. et al. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J. Urol. 155, 839–843 (1996).
Clark, W. F. et al. Urine volume and change in estimated GFR in a community-based cohort study. Clin. J. Am. Soc. Nephrol. 6, 2634–2641 (2011).
Strippoli, G. F. et al. Fluid and nutrient intake and risk of chronic kidney disease. Nephrology (Carlton) 16, 326–334 (2011).
Hebert, L. A., Greene, T., Levey, A., Falkenhain, M. E. & Klahr, S. High urine volume and low urine osmolality are risk factors for faster progression of renal disease. Am. J. Kidney Dis. 41, 962–971 (2003).
Daudon, M., Hennequin, C., Boujelben, G., Lacour, B. & Jungers, P. Serial crystalluria determination and the risk of recurrence in calcium stone formers. Kidney Int. 67, 1934–1943 (2005).
Embon, O. M., Rose, G. A. & Rosenbaum, T. Chronic dehydration stone disease. Br. J. Urol. 66, 357–362 (1990).
Hosking, D. H., Erickson, S. B., Van den Berg, C. J., Wilson, D. M. & Smith, L. H. The stone clinic effect in patients with idiopathic calcium urolithiasis. J. Urol. 130, 1115–1118 (1983).
Strauss, A. L., Coe, F. L., Deutsch, L. & Parks, J. H. Factors that predict relapse of calcium nephrolithiasis during treatment: a prospective study. Am. J. Med. 72, 17–24 (1982).
Sarica, K., Inal, Y., Erturhan, S. & Yagci, F. The effect of calcium channel blockers on stone regrowth and recurrence after shock wave lithotripsy. Urol. Res. 34, 184–189 (2006).
Curhan, G. C., Willett, W. C., Knight, E. L. & Stampfer, M. J. Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. Arch. Intern. Med. 164, 885–891 (2004).
Curhan, G. C., Willett, W. C., Rimm, E. B. & Stampfer, M. J. Family history and risk of kidney stones. J. Am. Soc. Nephrol. 8, 1568–1573 (1997).
Curhan, G. C., Willett, W. C., Speizer, F. E., Spiegelman, D. & Stampfer, M. J. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann. Intern. Med. 126, 497–504 (1997).
Taylor, E. N., Stampfer, M. J. & Curhan, G. C. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J. Am. Soc. Nephrol. 15, 3225–3232 (2004).
Rule, A. D. et al. Kidney stones and the risk for chronic kidney disease. Clin. J. Am. Soc. Nephrol. 4, 804–811 (2009).
Magpantay, L., Ziai, F., Oberbauer, R. & Haas, M. The effect of fluid intake on chronic kidney transplant failure: a pilot study. J. Renal Nutr. 21, 499–505 (2011).
Wang, C. J., Grantham, J. J. & Wetmore, J. B. The medicinal use of water in renal disease. Kidney Int. 84, 45–53 (2013).
Passfall, J., Pai, J., Spies, K. P., Haller, H. & Luft, F. C. Effect of water and bicarbonate loading in patients with chronic renal failure. Clin. Nephrol. 47, 92–98 (1997).
Reif, G. A. et al. Tolvaptan inhibits ERK-dependent cell proliferation, Cl− secretion, and in vitro cyst growth of human ADPKD cells stimulated by vasopressin. Am. J. Physiol. Renal Physiol. 301, F1005–F1013 (2011).
Higashihara, E. et al. Tolvaptan in autosomal dominant polycystic kidney disease: three years' experience. Clin. J. Am. Soc. Nephrol. 6, 2499–2507 (2011).
Torres, V. E. et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N. Engl. J. Med. 367, 2407–2418 (2012).
Wang, C. J., Creed, C., Winklhofer, F. T. & Grantham, J. J. Water prescription in autosomal dominant polycystic kidney disease: a pilot study. Clin. J. Am. Soc. Nephrol. 6, 192–197 (2011).
Barash, I., Ponda, M. P., Goldfarb, D. S. & Skolnik, E. Y. A pilot clinical study to evaluate changes in urine osmolality and urine cAMP in response to acute and chronic water loading in autosomal dominant polycystic kidney disease. Clin. J. Am. Soc. Nephrol. 5, 693–697 (2010).
Campbell, M. et al. Framework for design and evaluation of complex interventions to improve health. BMJ 321, 694–696 (2000).
Bihan, H. et al. Sociodemographic factors and attitudes toward food affordability and health are associated with fruit and vegetable consumption in a low-income French population. J. Nutr. 140, 823–830 (2010).
Weinstein, E., Galindo, R. J., Fried, M., Rucker, L. & Davis, N. J. Impact of a focused nutrition educational intervention coupled with improved access to fresh produce on purchasing behavior and consumption of fruits and vegetables in overweight patients with diabetes mellitus. Diabetes Educ. 40, 100–106 (2014).
Appel, L. J. et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N. Engl. J. Med. 336, 1117–1124 (1997).
Dansinger, M. L., Gleason, J. A., Griffith, J. L., Selker, H. P. & Schaefer, E. J. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293, 43–53 (2005).
Kothe, E. J. & Mullan, B. A. Acceptability of a theory of planned behaviour e-mail-based nutrition intervention. Health Promot. Int. 29, 81–90 (2014).
Ruffin, M. T. 4th et al. Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial. Ann. Fam. Med. 9, 3–11 (2011).
Edwards, S. J., Braunholtz, D. A., Lilford, R. J. & Stevens, A. J. Ethical issues in the design and conduct of cluster randomised controlled trials. BMJ 318, 1407–1409 (1999).
The authors declare no competing financial interests.
About this article
Cite this article
Jain, N., Reilly, R. Effects of dietary interventions on incidence and progression of CKD. Nat Rev Nephrol 10, 712–724 (2014). https://doi.org/10.1038/nrneph.2014.192
Intakes of long-chain omega-3 polyunsaturated fatty acids and non-fried fish in relation to incidence of chronic kidney disease in young adults: a 25-year follow-up
European Journal of Nutrition (2020)
Nature Reviews Nephrology (2019)
Adherence to the Mediterranean diet is associated with reduced risk of incident chronic kidney diseases among Tehranian adults
Hypertension Research (2017)
Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease
Journal of Behavioral Medicine (2017)
Der Internist (2016)