Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3–5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.
The idea that animal protein has ‘high biological value’ is not relevant in the context of a mixed diet and is not an a priori reason to consider plant protein inferior to animal protein for people with or without chronic kidney disease (CKD).
Plants are the only dietary source of fibre, which shifts the gut microbiota profile towards increased production of anti-inflammatory compounds and reduced production of uraemic toxins.
Plant fats, particularly olive oil, are anti-inflammatory and anti-atherogenic.
Plant-based diets have low net endogenous acid load, which could mitigate metabolic acidosis in patients with CKD and potentially slow the progression of kidney disease.
Plant phosphorus is bound to phytate and is less bioavailable than animal phosphorus; consequently, many plant-based foods have a favourable protein to phosphorus ratio.
Restriction of plant foods as a strategy to prevent hyperkalaemia deprives patients with CKD of the potential beneficial effects of these foods; plants with low potassium content provide choice for those who need to restrict their potassium intake.
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Kopple, J., Massry, S. & Kalantar-Zadeh, K. Nutritional Management of Renal Disease. 3rd edn, 1–48 (Lippincott Williams & Wilkins, 2012).
de Wardener, H. E. The control of sodium excretion. Am. J. Physiol. 235, F163–F173 (1978).
Weiner, I. D., Mitch, W. E. & Sands, J. M. Urea and ammonia metabolism and the control of renal nitrogen excretion. Clin. J. Am. Soc. Nephrol. 10, 1444–1458 (2015).
Triplitt, C. L. Understanding the kidneys’ role in blood glucose regulation. Am. J. Manag. Care 18, S11–S16 (2012).
Gerich, J. E. Role of the kidney in normal glucose homeostasis and in the hyperglycaemia of diabetes mellitus: therapeutic implications. Diabet. Med. 27, 136–142 (2010).
Weiner, I. D. & Verlander, J. W. Renal ammonia metabolism and transport. Compr. Physiol. 3, 201–220 (2013).
Maack, T., Johnson, V., Kau, S. T., Figueiredo, J. & Sigulem, D. Renal filtration, transport, and metabolism of low-molecular-weight proteins: a review. Kidney Int. 16, 251–270 (1979).
Waldmann, T. A., Strober, W. & Mogielnicki, R. P. The renal handling of low molecular weight proteins. II. Disorders of serum protein catabolism in patients with tubular proteinuria, the nephrotic syndrome, or uremia. J. Clin. Invest. 51, 2162–2174 (1972).
Al-Badr, W. & Martin, K. J. Vitamin D and kidney disease. Clin. J. Am. Soc. Nephrol. 3, 1555–1560 (2008).
Kopple, J. D. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am. J. Kidney Dis. 37, S66–S70 (2001).
Fouque, D. et al. EBPG guideline on nutrition. Nephrol. Dial. Transplant. 22 (Suppl 2), ii45–ii87 (2007).
Cupisti, A. et al. Nutritional treatment of advanced CKD: twenty consensus statements. J. Nephrol. 31, 457–473 (2018).
Campbell, K. L. & Carrero, J. J. Diet for the management of patients with chronic kidney disease; it is not the quantity, but the quality that matters. J. Ren. Nutr. 26, 279–281 (2016).
Fernandes, A. S., Ramos, C. I., Nerbass, F. B. & Cuppari, L. Diet quality of chronic kidney disease patients and the impact of nutritional counseling. J. Ren. Nutr. 28, 403–410 (2018).
Martins, A. M. et al. Elderly patients on hemodialysis have worse dietary quality and higher consumption of ultraprocessed food than elderly without chronic kidney disease. Nutrition 41, 73–79 (2017).
Luis, D. et al. Dietary quality and adherence to dietary recommendations in patients undergoing hemodialysis. J. Ren. Nutr. 26, 190–195 (2016).
Therrien, M., Byham-Gray, L., Denmark, R. & Beto, J. Comparison of dietary intake among women on maintenance dialysis to a Women’s Health Initiative cohort: results from the NKF-CRN second national research question collaborative study. J. Ren. Nutr. 24, 72–80 (2014).
Williams, K. A. Sr. & Patel, H. Healthy plant-based diet: what does it really mean? J. Am. Coll. Cardiol. 70, 423–425 (2017).
Muraki, I. et al. Potato consumption and risk of type 2 diabetes: results from three prospective cohort studies. Diabetes Care 39, 376–384 (2016).
Yang, Q. et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern. Med. 174, 516–524 (2014).
Biological value http://www.wikidoc.org/index.php/Biological_value (2002)
[No author]. Nitrogen retention in man in relation to the level and pattern of essential amino acids. Nutr. Rev. 27, 111–113 (1969).
WHO/FAO/ONU. Protein and amino acid requirements in human nutrition: report of a joint WHO/FAO/ONU Expert Consultation (2007).
Chan, M., Kelly, J. & Tapsell, L. Dietary modeling of foods for advanced CKD based on general healthy eating guidelines: what should be on the plate? Am. J. Kidney Dis. 69, 436–450 (2017).
Millward, D. J. Identifying recommended dietary allowances for protein and amino acids: a critique of the 2007 WHO/FAO/UNU report. Br. J. Nutr. 108 (Suppl 2), S3–S21 (2012).
Rand, W. M., Pellett, P. L. & Young, V. R. Meta-analysis of nitrogen balance studies for estimating protein requirements in healthy adults. Am. J. Clin. Nutr. 77, 109–127 (2003).
Millward, D. J. The nutritional value of plant-based diets in relation to human amino acid and protein requirements. Proc. Nutr. Soc. 58, 249–260 (1999).
Young, V. R. & Pellett, P. L. Plant proteins in relation to human protein and amino acid nutrition. Am. J. Clin. Nutr. 59, 1203s–1212s (1994).
Oosterwijk, M. M. et al. High dietary intake of vegetable protein is associated with lower prevalence of renal function impairment: results of the Dutch DIALECT-1 cohort. Kidney Int. Rep. 4, 710–719 (2019).
Haring, B. et al. Dietary protein sources and risk for incident chronic kidney disease: results from the atherosclerosis risk in communities (ARIC) study. J. Renal Nutr. 27, 233–242 (2017).
Chen, X. et al. The associations of plant protein intake with all-cause mortality in CKD. Am. J. Kidney Dis. 67, 423–430 (2016).
Kelly, J. T. & Carrero, J. J. Dietary sources of protein and chronic kidney disease progression: the proof may be in the pattern. J. Ren. Nutr. 27, 221–224 (2017).
Frigolet, M. E., Torres, N. & Tovar, A. R. Soya protein attenuates abnormalities of the renin-angiotensin system in adipose tissue from obese rats. Br. J. Nutr. 107, 36–44 (2012).
Iwasaki, K. et al. The influence of dietary protein source on longevity and age-related disease processes of Fischer rats. J. Gerontol. 43, B5–B12 (1988).
Nakamura, H., Ito, S., Ebe, N. & Shibata, A. Renal effects of different types of protein in healthy volunteer subjects and diabetic patients. Diabetes Care 16, 1071–1075 (1993).
Woods, L. L. Mechanisms of renal hemodynamic regulation in response to protein feeding. Kidney Int. 44, 659–675 (1993).
Kontessis, P. et al. Renal, metabolic and hormonal responses to ingestion of animal and vegetable proteins. Kidney Int. 38, 136–144 (1990).
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).
Johnson, R. J. et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am. J. Clin. Nutr. 86, 899–906 (2007).
Medicine Institute. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty acids, Cholesterol, Protein and Amino acids (Institute of Medicine, 2002).
Bozzetto, L. et al. Dietary fibre as a unifying remedy for the whole spectrum of obesity-associated cardiovascular risk. Nutrients 10, 943 (2018).
Anderson, J. W. et al. Postprandial serum glucose, insulin, and lipoprotein responses to high- and low-fiber diets. Metabolism 44, 848–854 (1995).
Stephen, A. M. & Cummings, J. H. Mechanism of action of dietary fibre in the human colon. Nature 284, 283–284 (1980).
Chiavaroli, L., Mirrahimi, A., Sievenpiper, J. L., Jenkins, D. J. & Darling, P. B. Dietary fiber effects in chronic kidney disease: a systematic review and meta-analysis of controlled feeding trials. Eur. J. Clin. Nutr. 69, 761–768 (2015).
Diaz-Lopez, A. et al. Cross-sectional associations between macronutrient intake and chronic kidney disease in a population at high cardiovascular risk. Clin. Nutr. 32, 606–612 (2013).
Xu, H. et al. Dietary fiber, kidney function, inflammation, and mortality risk. Clin. J. Am. Soc. Nephrol. 9, 2104–2110 (2014).
Gopinath, B. et al. Carbohydrate nutrition is associated with the 5-year incidence of chronic kidney disease. J. Nutr. 141, 433–439 (2011).
Fujii, H. et al. Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka diabetes registry. Nutr. J. 12, 159 (2013).
Krishnamurthy, V. M. et al. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int. 81, 300–306 (2012).
Erthal Leinig, C. et al. Low-fiber intake is associated with high production of intraperitoneal inflammation biomarkers. J. Ren. Nutr. 29, 322–327 (2019).
Demirci, B. G., Tutal, E., Eminsoy, I. O., Kulah, E. & Sezer, S. Dietary fiber intake: its relation with glycation end products and arterial stiffness in end-stage renal disease patients. J. Ren. Nutr. 29, 136–142 (2019).
Wang, A. Y. et al. Dietary fiber intake, myocardial injury, and major adverse cardiovascular events among end-stage kidney disease patients: a prospective cohort study. Kidney Int. Rep. 4, 814–823 (2019).
Xu, X., Li, Z., Chen, Y., Liu, X. & Dong, J. Dietary fiber and mortality risk in patients on peritoneal dialysis. Br J Nutr 122, 996–1005 (2019).
Noori, N. et al. Dietary intakes of fiber and magnesium and incidence of metabolic syndrome in first year after renal transplantation. J. Ren. Nutr. 20, 101–111 (2010).
Sirich, T. L., Plummer, N. S., Gardner, C. D., Hostetter, T. H. & Meyer, T. W. Effect of increasing dietary fiber on plasma levels of colon-derived solutes in hemodialysis patients. Clin. J. Am. Soc. Nephrol. 9, 1603–1610 (2014).
Xie, L. M., Ge, Y. Y., Huang, X., Zhang, Y. Q. & Li, J. X. Effects of fermentable dietary fiber supplementation on oxidative and inflammatory status in hemodialysis patients. Int. J. Clin. Exp. Med. 8, 1363–1369 (2015).
Salmean, Y. A., Segal, M. S., Palii, S. P. & Dahl, W. J. Fiber supplementation lowers plasma p-cresol in chronic kidney disease patients. J. Ren. Nutr. 25, 316–320 (2015).
Salmean, Y. A. et al. Foods with added fiber lower serum creatinine levels in patients with chronic kidney disease. J. Ren. Nutr. 23, e29–e32 (2013).
De Filippis, F. et al. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut 65, 1812–1821 (2016).
Mitsou, E. K. et al. Adherence to the Mediterranean diet is associated with the gut microbiota pattern and gastrointestinal characteristics in an adult population. Br. J. Nutr. 117, 1645–1655 (2017).
Garcia-Mantrana, I., Selma-Royo, M., Alcantara, C. & Collado, M. C. Shifts on gut microbiota associated to mediterranean diet adherence and specific dietary intakes on general adult population. Front. Microbiol. 9, 890 (2018).
Duranton, F. et al. Normal and pathologic concentrations of uremic toxins. J. Am. Soc. Nephrol. 23, 1258–1270 (2012).
Niwa, T. Role of indoxyl sulfate in the progression of chronic kidney disease and cardiovascular disease: experimental and clinical effects of oral sorbent AST-120. Ther. Apher. Dial. 15, 120–124 (2011).
Rossi, M. et al. Dietary protein-fiber ratio associates with circulating levels of indoxyl sulfate and p-cresyl sulfate in chronic kidney disease patients. Nutr. Metab. Cardiovasc. Dis. 25, 860–865 (2015).
Xu, H. et al. Excess protein intake relative to fiber and cardiovascular events in elderly men with chronic kidney disease. Nutr. Metab. Cardiovasc. Dis. 26, 597–602 (2016).
Ferdowsian, H. R. & Barnard, N. D. Effects of plant-based diets on plasma lipids. Am. J. Cardiol. 104, 947–956 (2009).
Tonstad, S., Butler, T., Yan, R. & Fraser, G. E. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 32, 791–796 (2009).
Severson, T., Kris-Etherton, P. M., Robinson, J. G. & Guyton, J. R. Roundtable discussion: dietary fats in prevention of atherosclerotic cardiovascular disease. J. Clin. Lipidol. 12, 574–582 (2018).
Huang, X., Lindholm, B., Stenvinkel, P. & Carrero, J. J. Dietary fat modification in patients with chronic kidney disease: n-3 fatty acids and beyond. J. Nephrol. 26, 960–974 (2013).
Sales-Campos, H., Souza, P. R., Peghini, B. C., da Silva, J. S. & Cardoso, C. R. An overview of the modulatory effects of oleic acid in health and disease. Mini Rev. Med. Chem. 13, 201–210 (2013).
Massaro, M. & De Caterina, R. Vasculoprotective effects of oleic acid: epidemiological background and direct vascular antiatherogenic properties. Nutr. Metab. Cardiovasc. Dis. 12, 42–51 (2002).
Dos Santos, A. L. T. et al. Low linolenic and linoleic acid consumption are associated with chronic kidney disease in patients with type 2 diabetes. PLoS One 13, e0195249 (2018).
Huang, X. et al. Serum fatty acid patterns, insulin sensitivity and the metabolic syndrome in individuals with chronic kidney disease. J. Intern. Med. 275, 71–83 (2014).
Huang, X. et al. Essential polyunsaturated fatty acids, inflammation and mortality in dialysis patients. Nephrol. Dial. Transplant. 27, 3615–3620 (2012).
Lin, J. et al. Associations of dietary fat with albuminuria and kidney dysfunction. Am. J. Clin. Nutr. 92, 897–904 (2010).
Huang, X. et al. Clinical determinants and mortality predictability of stearoyl-CoA desaturase-1 activity indices in dialysis patients. J. Intern. Med. 273, 263–272 (2013).
Lin, J., Hu, F. B. & Curhan, G. C. Associations of diet with albuminuria and kidney function decline. Clin. J. Am. Soc. Nephrol. 5, 836–843 (2010).
Wesson, D. E. Endogenous endothelins mediate increased acidification in remnant kidneys. J. Am. Soc. Nephrol. 12, 1826–1835 (2001).
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).
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).
Yuan, Y. et al. Short-chain fatty acids production and microbial community in sludge alkaline fermentation: long-term effect of temperature. Bioresour. Technol. 211, 685–690 (2016).
Morrison, D. J. & Preston, T. Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism. Gut Microbes 7, 189–200 (2016).
Xu, C., Cheng, C., Zhang, X. & Peng, J. Inclusion of soluble fiber in the gestation diet changes the gut microbiota, affects plasma propionate and odd-chain fatty acids levels, and improves insulin sensitivity in sows. Int. J. Mol. Sci. 21, 635 (2020).
Sakata, T. Stimulatory effect of short-chain fatty acids on epithelial cell proliferation in the rat intestine: a possible explanation for trophic effects of fermentable fibre, gut microbes and luminal trophic factors. Br. J. Nutr. 58, 95–103 (1987).
Esgalhado, M., Kemp, J. A., Rt Damasceno, N., Fouque, D. & Mafra, D. Short-chain fatty acids: a link between prebiotics and microbiota in chronic kidney disease. Future Microbiol. 12, 1413–1425 (2017).
Banerjee, T. et al. Dietary acid load and chronic kidney disease among adults in the United States. BMC Nephrol. 15, 137 (2014).
Ko, B. J. et al. Dietary acid load and chronic kidney disease in elderly adults: protein and potassium intake. PLoS One 12, e0185069 (2017).
Rebholz, C. M. et al. Dietary acid load and incident chronic kidney disease: results from the ARIC study. Am. J. Nephrol. 42, 427–435 (2015).
Banerjee, T. et al. Dietary potential renal acid load and risk of albuminuria and reduced kidney function in the Jackson heart study. J. Ren. Nutr. 28, 251–258 (2018).
Kanda, E., Ai, M., Kuriyama, R., Yoshida, M. & Shiigai, T. Dietary acid intake and kidney disease progression in the elderly. Am. J. Nephrol. 39, 145–152 (2014).
Banerjee, T. et al. High dietary acid load predicts ESRD among adults with CKD. J. Am. Soc. Nephrol. 26, 1693–1700 (2015).
Scialla, J. J. et al. Net endogenous acid production is associated with a faster decline in GFR in African Americans. Kidney Int. 82, 106–112 (2012).
Crews, D. C. et al. Race/ethnicity, dietary acid load, and risk of end-stage renal disease among US adults with chronic kidney disease. Am. J. Nephrol. 47, 174–181 (2018).
Scialla, J. J. et al. Higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes. Kidney Int. 91, 204–215 (2017).
Khairallah, P. et al. Acid load and phosphorus homeostasis in CKD. Am. J. Kidney Dis. 70, 541–550 (2017).
Passey, C. Reducing the dietary acid load: how a more alkaline diet benefits patients with chronic kidney disease. J. Ren. Nutr. 27, 151–160 (2017).
Glew, R. H. et al. Nephropathy in dietary hyperoxaluria: a potentially preventable acute or chronic kidney disease. World J. Nephrol. 3, 122–142 (2014).
Karp, H. J., Vaihia, K. P., Karkkainen, M. U., Niemisto, M. J. & Lamberg-Allardt, C. J. Acute effects of different phosphorus sources on calcium and bone metabolism in young women: a whole-foods approach. Calcif. Tissue Int. 80, 251–258 (2007).
Janmaat, C. J. et al. Lower serum calcium is independently associated with CKD progression. Sci. Rep. 8, 5148 (2018).
KDOQI. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am. J. Kidney Dis. 42, S1–201 (2003).
KDIGO. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl. 7, 1–59 (2017).
Ketteler, M. et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) guideline update: what’s changed and why it matters. Kidney Int. 92, 26–36 (2017).
Moe, S. M. et al. Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin. J. Am. Soc. Nephrol. 6, 257–264 (2011).
Moorthi, R. N. et al. The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease. Am. J. Nephrol. 40, 582–591 (2014).
Scialla, J. J. et al. Plant protein intake is associated with fibroblast growth factor 23 and serum bicarbonate levels in patients with chronic kidney disease: the chronic renal insufficiency cohort study. J. Ren. Nutr. 22, 379–388.e371 (2012).
Macdonald-Clarke, C. J. et al. Bioavailability of potassium from potatoes and potassium gluconate: a randomized dose response trial. Am. J. Clin. Nutr. 104, 346–353 (2016).
Holbrook, J. T. et al. Sodium and potassium intake and balance in adults consuming self-selected diets. Am. J. Clin. Nutr. 40, 786–793 (1984).
Bechgaard, H. & Shephard, N. W. Bioavailability of potassium from controlled-release tablets with and without water loading. Eur. J. Clin. Pharmacol. 21, 143–147 (1981).
Betlach, C. J., Arnold, J. D., Frost, R. W., Leese, P. T. & Gonzalez, M. A. Bioavailability and pharmacokinetics of a new sustained-release potassium chloride tablet. Pharm. Res. 4, 409–411 (1987).
Prajapati, K. & Modi, H. A. The importance of potassium in plant growth — a review. Indian. J. Plant. Sci. 1, 177–186 (2012).
St-Jules, D. E., Goldfarb, D. S. & Sevick, M. A. Nutrient non-equivalence: does restricting high-potassium plant foods help to prevent hyperkalemia in hemodialysis patients? J. Ren. Nutr. 26, 282–287 (2016).
Palmer, S. C. et al. Dietary and fluid restrictions in CKD: a thematic synthesis of patient views from qualitative studies. Am. J. Kidney Dis. 65, 559–573 (2015).
Carlisle, E. J. et al. Modulation of the secretion of potassium by accompanying anions in humans. Kidney Int. 39, 1206–1212 (1991).
Cupisti, A., Kovesdy, C. P., D’Alessandro, C. & Kalantar-Zadeh, K. Dietary approach to recurrent or chronic hyperkalaemia in patients with decreased kidney function. Nutrients 10, 261 (2018).
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).
Naismith, D. J. & Braschi, A. An investigation into the bioaccessibility of potassium in unprocessed fruits and vegetables. Int. J. Food Sci. Nutr. 59, 438–450 (2008).
Birukov, A. et al. Ultra-long-term human salt balance studies reveal interrelations between sodium, potassium, and chloride intake and excretion. Am. J. Clin. Nutr. 104, 49–57 (2016).
Gritter, M. et al. Rationale and design of a randomized placebo-controlled clinical trial assessing the renoprotective effects of potassium supplementation in chronic kidney disease. Nephron 140, 48–57 (2018).
He, J. et al. Urinary sodium and potassium excretion and CKD progression. J. Am. Soc. Nephrol. 27, 1202–1212 (2016).
Kim, H. W. et al. Urinary potassium excretion and progression of CKD. Clin. J. Am. Soc. Nephrol. 14, 330–340 (2019).
Leonberg-Yoo, A. K., Tighiouart, H., Levey, A. S., Beck, G. J. & Sarnak, M. J. Urine potassium excretion, kidney failure, and mortality in CKD. Am. J. Kidney Dis. 69, 341–349 (2017).
Arnold, R. et al. Randomized, controlled trial of the effect of dietary potassium restriction on nerve function in CKD. Clin. J. Am. Soc. Nephrol. 12, 1569–1577 (2017).
Noori, N. et al. Dietary potassium intake and mortality in long-term hemodialysis patients. Am. J. Kidney Dis. 56, 338–347 (2010).
Eisenga, M. F. et al. Urinary potassium excretion, renal ammoniagenesis, and risk of graft failure and mortality in renal transplant recipients. Am. J. Clin. Nutr. 104, 1703–1711 (2016).
Tepel, M., van der Giet, M., Statz, M., Jankowski, J. & Zidek, W. The antioxidant acetylcysteine reduces cardiovascular events in patients with end-stage renal failure: a randomized, controlled trial. Circulation 107, 992–995 (2003).
Scholze, A. et al. Acetylcysteine reduces plasma homocysteine concentration and improves pulse pressure and endothelial function in patients with end-stage renal failure. Circulation 109, 369–374 (2004).
Holden, R. M., Ki, V., Morton, A. R. & Clase, C. Fat-soluble vitamins in advanced CKD/ESKD: a review. Semin. Dial. 25, 334–343 (2012).
Clase, C. M., Ki, V. & Holden, R. M. Water-soluble vitamins in people with low glomerular filtration rate or on dialysis: a review. Semin. Dial. 26, 546–567 (2013).
Silaghi, C. N. et al. Vitamin K dependent proteins in kidney disease. Int. J. Mol. Sci. 20, 1571 (2019).
Cozzolino, M. et al. Vitamin K in chronic kidney disease. Nutrients 10, 1076 (2019).
Zeraatkar, D. et al. Red and processed meat consumption and risk for all-cause mortality and cardiometabolic outcomes: a systematic review and meta-analysis of cohort studies. Ann. Intern. Med. https://doi.org/10.7326/m19-0655 (2019).
Johnston, B. C. et al. Unprocessed red meat and processed meat consumption: dietary guideline recommendations from the nutritional recommendations (NutriRECS) consortium. Ann. Intern. Med. https://doi.org/10.7326/m19-1621 (2019).
Neuhouser, M. L. Red and processed meat: more with less? Am. J. Clin. Nutr. 111, 252–255 (2019).
Qian, F., Riddle, M. C., Wylie-Rosett, J. & Hu, F. B. Red and processed meats and health risks: how strong is the evidence? Diabetes Care 43, 265–271 (2020).
Jhee, J. H. et al. A diet rich in vegetables and fruit and incident CKD: a community-based prospective cohort study. Am. J. Kidney Dis. 74, 491–500 (2019).
Dunkler, D. et al. Dietary risk factors for incidence or progression of chronic kidney disease in individuals with type 2 diabetes in the European Union. Nephrol. Dialysis Transplant. 30 (Suppl 4), iv76–iv85 (2015).
Dunkler, D. et al. Population-attributable fractions of modifiable lifestyle factors for CKD and mortality in individuals with type 2 diabetes: a cohort study. Am. J. Kidney Dis. 68, 29–40 (2016).
Ajjarapu, A. S. et al. Nut consumption and renal function among women with a history of gestational diabetes. J. Renal Nutr. https://doi.org/10.1053/j.jrn.2019.10.005 (2020).
Herber-Gast, G. M. et al. Consumption of whole grains, fruit and vegetables is not associated with indices of renal function in the population-based longitudinal Doetinchem study. Br. J. Nutr. 118, 375–382 (2017).
Ma, J. et al. Dietary guideline adherence index and kidney measures in the Framingham Heart Study. Am. J. Kidney Dis. 68, 703–715 (2016).
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).
Goraya, N., Simoni, J., Jo, C. H. & Wesson, D. E. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. Kidney Int. 86, 1031–1038 (2014).
Goraya, N., Munoz-Maldonado, Y., Simoni, J. & Wesson, D. E. Fruit and vegetable treatment of chronic kidney disease-related metabolic acidosis reduces cardiovascular risk better than sodium bicarbonate. Am. J. Nephrol. 49, 438–448 (2019).
Fanti, P., Asmis, R., Stephenson, T. J., Sawaya, B. P. & Franke, A. A. Positive effect of dietary soy in ESRD patients with systemic inflammation-correlation between blood levels of the soy isoflavones and the acute-phase reactants. Nephrol. Dialysis Transplant. 21, 2239–2246 (2006).
Tabibi, H., Imani, H., Hedayati, M., Atabak, S. & Rahmani, L. Effects of soy consumption on serum lipids and apoproteins in peritoneal dialysis patients: a randomized controlled trial. Perit. Dialysis Int. 30, 611–618 (2010).
Cupisti, A. et al. Effect of a soy protein diet on serum lipids of renal transplant patients. J. Ren. Nutr. 14, 31–35 (2004).
Chauveau, P. et al. Mediterranean diet as the diet of choice for patients with chronic kidney disease. Nephrol. Dialysis Transplant. 33, 725–735 (2018).
Bach, K. E. et al. Healthy dietary patterns and incidence of CKD: a meta-analysis of cohort studies. Clin. J. Am. Soc. Nephrol. 14, 1441–1449, https://doi.org/10.2215/cjn.00530119 (2019).
Kelly, J. T. et al. Healthy dietary patterns and risk of mortality and ESRD in CKD: a meta-analysis of cohort studies. Clin. J. Am. Soc. Nephrol. 12, 272–279 (2017).
Mekki, K., Bouzidi-bekada, N., Kaddous, A. & Bouchenak, M. Mediterranean diet improves dyslipidemia and biomarkers in chronic renal failure patients. Food Funct. 1, 110–115 (2010).
Tyson, C. C. et al. Short-term effects of the DASH diet in adults with moderate chronic kidney disease: a pilot feeding study. Clin. Kidney J. 9, 592–598 (2016).
Joshi, S., Shah, S. & Kalantar-Zadeh, K. Adequacy of plant-based proteins in chronic kidney disease. J. Ren. Nutr. 29, 112–117 (2019).
Piccoli, G. B. et al. Low-protein diets in CKD: how can we achieve them? A narrative, pragmatic review. Clin. Kidney J. 8, 61–70 (2015).
Piccoli, G. B. et al. Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines? BMC Nephrol. 17, 76 (2016).
Barsotti, G. et al. A low-nitrogen low-phosphorus vegan diet for patients with chronic renal failure. Nephron 74, 390–394 (1996).
Soroka, N. et al. Comparison of a vegetable-based (soya) and an animal-based low-protein diet in predialysis chronic renal failure patients. Nephron 79, 173–180 (1998).
Marzocco, S. et al. Very low protein diet reduces indoxyl sulfate levels in chronic kidney disease. Blood Purif. 35, 196–201 (2013).
Black, A. P. et al. Does low-protein diet influence the uremic toxin serum levels from the gut microbiota in nondialysis chronic kidney disease patients? J. Ren. Nutr. 28, 208–214 (2018).
Nafar, M. et al. Mediterranean diets are associated with a lower incidence of metabolic syndrome one year following renal transplantation. Kidney Int. 76, 1199–1206 (2009).
Oste, M. C. J. et al. Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients. Am. J. Transplant. 18, 2523–2533 (2018).
Saglimbene, V. M. et al. Fruit and vegetable intake and mortality in adults undergoing maintenance hemodialysis. Clin. J. Am. Soc. Nephrol. 14, 250–260 (2019).
Saglimbene, V. M. et al. The association of Mediterranean and DASH diets with mortality in adults on hemodialysis: the DIET-HD multinational cohort study. J. Am. Soc. Nephrol. 29, 1741–1751 (2018).
Saglimbene, V. M. et al. Dietary patterns and mortality in a multinational cohort of adults receiving hemodialysis. Am. J. Kidney Dis. 75, 361–372 (2019).
Davey, G. K. et al. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public. Health Nutr. 6, 259–269 (2003).
Schmidt, J. A. et al. Plasma concentrations and intakes of amino acids in male meat-eaters, fish-eaters, vegetarians and vegans: a cross-sectional analysis in the EPIC-Oxford cohort. Eur. J. Clin. Nutr. 70, 306–312 (2016).
Setchell, K. D. & Lydeking-Olsen, E. Dietary phytoestrogens and their effect on bone: evidence from in vitro and in vivo, human observational, and dietary intervention studies. Am. J. Clin. Nutr. 78, 593s–609s (2003).
Rizzo, N. S., Jaceldo-Siegl, K., Sabate, J. & Fraser, G. E. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J. Acad. Nutr. Diet. 113, 1610–1619 (2013).
Huang, C. J., Fan, Y. C., Liu, J. F. & Tsai, P. S. Characteristics and nutrient intake of Taiwanese elderly vegetarians: evidence from a national survey. Br. J. Nutr. 106, 451–460 (2011).
Patel, K. P., Luo, F. J., Plummer, N. S., Hostetter, T. H. & Meyer, T. W. The production of p-cresol sulfate and indoxyl sulfate in vegetarians versus omnivores. Clin. J. Am. Soc. Nephrol. 7, 982–988 (2012).
Kandouz, S., Mohamed, A. S., Zheng, Y., Sandeman, S. & Davenport, A. Reduced protein bound uraemic toxins in vegetarian kidney failure patients treated by haemodiafiltration. Hemodialysis international. Int. Symposium Home Hemodial. 20, 610–617 (2016).
Wu, T. T. et al. Nutritional status of vegetarians on maintenance haemodialysis. Nephrology 16, 582–587 (2011).
Chiu, S. et al. Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial. Am. J. Clin. Nutr. 103, 341–347 (2016).
Du, S. et al. Understanding the patterns and trends of sodium intake, potassium intake, and sodium to potassium ratio and their effect on hypertension in China. Am. J. Clin. Nutr. 99, 334–343 (2014).
Mente, A. et al. Association of urinary sodium and potassium excretion with blood pressure. N. Engl. J. Med. 371, 601–611 (2014).
[No authors listed]. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ 297, 319–328 (1988).
Aburto, N. J. et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 346, f1378 (2013).
Kovesdy, C. P. et al. Potassium homeostasis in health and disease: a scientific workshop cosponsored by the National Kidney Foundation and the American Society of Hypertension. J. Am. Soc. Hypertens. 11, 783–800 (2017).
De Nicola, L., Di Lullo, L., Paoletti, E., Cupisti, A. & Bianchi, S. Chronic hyperkalemia in non-dialysis CKD: controversial issues in nephrology practice. J. Nephrol. 31, 653–664 (2018).
Clase, C. M. et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. Kidney Int. 97, 42–61 (2020).
St-Jules, D. E., Woolf, K., Pompeii, M. L. & Sevick, M. A. Exploring problems in following the hemodialysis diet and their relation to energy and nutrient intakes: the balancewise study. J. Ren. Nutr. 26, 118–124 (2016).
Smyth, A. et al. The relationship between estimated sodium and potassium excretion and subsequent renal outcomes. Kidney Int. 86, 1205–1212 (2014).
Jones, W. L. Demineralization of a wide variety of foods for the renal patient. J. Ren. Nutr. 11, 90–96 (2001).
Palmer, B. F. Regulation of potassium homeostasis. Clin. J. Am. Soc. Nephrol. 10, 1050–1060 (2015).
Hayes, C. P. Jr., McLeod, M. E. & Robinson, R. R. An extravenal mechanism for the maintenance of potassium balance in severe chronic renal failure. Trans. Assoc. Am. Physicians 80, 207–216 (1967).
Mathialahan, T., Maclennan, K. A., Sandle, L. N., Verbeke, C. & Sandle, G. I. Enhanced large intestinal potassium permeability in end-stage renal disease. J. Pathol. 206, 46–51 (2005).
Sterns, R. H., Feig, P. U., Pring, M., Guzzo, J. & Singer, I. Disposition of intravenous potassium in anuric man: a kinetic analysis. Kidney Int. 15, 651–660 (1979).
Blumberg, A., Weidmann, P. & Ferrari, P. Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Kidney Int. 41, 369–374 (1992).
Alvestrand, A., Wahren, J., Smith, D. & DeFronzo, R. A. Insulin-mediated potassium uptake is normal in uremic and healthy subjects. Am. J. Physiol. 246, E174–E180 (1984).
Allon, M., Dansby, L. & Shanklin, N. Glucose modulation of the disposal of an acute potassium load in patients with end-stage renal disease. Am. J. Med. 94, 475–482 (1993).
Winkler, A. W., Hoff, H. E. & Smith, P. K. The toxicity of orally administered potassium salts in renal insufficiency. J. Clin. Invest. 20, 119–126 (1941).
Keith, N. M. & Osterberg, A. E. The tolerance for potassium in severe renal insufficiency; a study of 10 cases. J. Clin. Invest. 26, 773–783 (1947).
Khair, K. Compliance, concordance and adherence: what are we talking about? Haemophilia 20, 601–603 (2014).
Jha, V. et al. Chronic kidney disease: global dimension and perspectives. Lancet 382, 260–272 (2013).
Kelly, J. T. et al. Feasibility and acceptability of telehealth coaching to promote healthy eating in chronic kidney disease: a mixed-methods process evaluation. BMJ Open. 9, e024551 (2019).
Warner, M. M., Tong, A., Campbell, K. L. & Kelly, J. T. Patients’ experiences and perspectives of telehealth coaching with a dietitian to improve diet quality in chronic kidney disease: a qualitative interview study. J. Acad. Nutr. Diet. 119, 1362–1374 (2019).
Katz, I. J. et al. iConnect CKD - virtual medical consulting: a web-based chronic kidney disease, hypertension and diabetes integrated care program. Nephrology 23, 646–652 (2018).
Sherman, R. A. & Mehta, O. Phosphorus and potassium content of enhanced meat and poultry products: implications for patients who receive dialysis. Clin. J. Am. Soc. Nephrol. 4, 1370–1373 (2009).
Parpia, A. S. et al. The impact of additives on the phosphorus, potassium, and sodium content of commonly consumed meat, poultry, and fish products among patients with chronic kidney disease. J. Ren. Nutr. 28, 83–90 (2018).
Parpia, A. S. et al. Sodium-reduced meat and poultry products contain a significant amount of potassium from food additives. J. Acad. Nutr. Diet. 118, 878–885 (2018).
Reynolds, A. et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 393, 434–445 (2019).
Threapleton, D. E. et al. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 347, f6879 (2013).
Veronese, N. et al. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. Am. J. Clin. Nutr. 107, 436–444 (2018).
D’Alessandro, C. et al. “Dietaly”: practical issues for the nutritional management of CKD patients in Italy. BMC Nephrol. 17, 102 (2016).
Melina, V., Craig, W. & Levin, S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J. Acad. Nutr. Diet. 116, 1970–1980 (2016).
Agnoli, C. et al. Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Nutr. Metab. Cardiovasc. Dis. 27, 1037–1052 (2017).
St-Jules, D. E., Goldfarb, D. S., Popp, C. J., Pompeii, M. L. & Liebman, S. E. Managing protein-energy wasting in hemodialysis patients: a comparison of animal- and plant-based protein foods. Semin. Dial. 32, 41–46 (2019).
Berman, T. et al. Urinary concentrations of organophosphate and carbamate pesticides in residents of a vegetarian community. Environ. Int. 96, 34–40 (2016).
Sari, Y. W., Mulder, W. J., Sanders, J. P. & Bruins, M. E. Towards plant protein refinery: review on protein extraction using alkali and potential enzymatic assistance. Biotechnol. J. 10, 1138–1157 (2015).
Welte, A. L., Harpel, T., Schumacher, J. & Barnes, J. L. Registered dietitian nutritionists and perceptions of liberalizing the hemodialysis diet. Nutr. Res. Pract. 13, 310–315 (2019).
Austel, A., Ranke, C., Wagner, N., Gorge, J. & Ellrott, T. Weight loss with a modified Mediterranean-type diet using fat modification: a randomized controlled trial. Eur. J. Clin. Nutr. 69, 878–884 (2015).
de Almeida Alvarenga, L. et al. Cranberries — potential benefits in patients with chronic kidney disease. Food Funct. 10, 3103–3112 (2019).
Vargas, F. et al. Flavonoids in kidney health and disease. Front. Physiol. 9, 394 (2018).
Li, W. et al. Lycopene ameliorates renal function in rats with streptozotocin-induced diabetes. Int. J. Clin. Exp. Pathol. 7, 5008–5015 (2014).
Deicher, R., Ziai, F., Bieglmayer, C., Schillinger, M. & Horl, W. H. Low total vitamin C plasma level is a risk factor for cardiovascular morbidity and mortality in hemodialysis patients. J. Am. Soc. Nephrol. 16, 1811–1818 (2005).
Heinz, J., Kropf, S., Luley, C. & Dierkes, J. Homocysteine as a risk factor for cardiovascular disease in patients treated by dialysis: a meta-analysis. Am. J. Kidney Dis. 54, 478–489 (2009).
Capelli, I. et al. Folic acid and vitamin B12 administration in CKD, why not? Nutrients 11, 383 (2019).
Heinz, J. et al. Washout of water-soluble vitamins and of homocysteine during haemodialysis: effect of high-flux and low-flux dialyser membranes. Nephrology 13, 384–389 (2008).
Russo, G. et al. Monitoring oral iron therapy in children with iron deficiency anemia: an observational, prospective, multicenter study of AIEOP patients (Associazione Italiana Emato-Oncologia Pediatrica). Ann. Hematol. 99, 413–420 (2020).
Floege, J. Magnesium in CKD: more than a calcification inhibitor? J. Nephrol. 28, 269–277 (2014).
Van Laecke, S., Nagler, E. V., Verbeke, F., Van Biesen, W. & Vanholder, R. Hypomagnesemia and the risk of death and GFR decline in chronic kidney disease. Am. J. Med. 126, 825–831 (2013).
Damianaki, K. et al. Renal handling of zinc in chronic kidney disease patients and the role of circulating zinc levels in renal function decline. Nephrol. Dialysis Transplant. https://doi.org/10.1093/ndt/gfz065 (2019).
Liu, H. W., Tsai, W. H., Liu, J. S. & Kuo, K. L. Association of vegetarian diet with chronic kidney disease. Nutrients 11, 279 (2019).
Asghari, G., Yuzbashian, E., Mirmiran, P. & Azizi, F. The association between dietary approaches to stop hypertension and incidence of chronic kidney disease in adults: the Tehran lipid and glucose study. Nephrol. Dialysis Transplant. 32, ii224–ii230 (2017).
Asghari, G., Momenan, M., Yuzbashian, E., Mirmiran, P. & Azizi, F. Dietary pattern and incidence of chronic kidney disease among adults: a population-based study. Nutr. Metab. 15, 88 (2018).
Kim, H. et al. Plant-based diets and incident CKD and kidney function. Clin. J. Am. Soc. Nephrol. 14, 682–691 (2019).
Hu, E. A. et al. Dietary patterns and risk of incident chronic kidney disease: the atherosclerosis risk in communities study. Am. J. Clin. Nutr. 110, 713–721 (2019).
Gutierrez, O. M. et al. Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study. Am. J. Kidney Dis. 64, 204–213 (2014).
Banerjee, T. et al. Poor accordance to a DASH dietary pattern is associated with higher risk of ESRD among adults with moderate chronic kidney disease and hypertension. Kidney Int. 95, 1433–1442 (2019).
National Kidney Foundation. Dietary guidelines for adults starting on haemodialysis. https://www.kidney.org/atoz/content/dietary_hemodialysis (2019).
United States Department of Agriculture. USDA national nutrient database for standard, https://ndb.nal.usda.gov/nd (2013).
Fujii, H., Goto, S. & Fukagawa, M. Role of uremic toxins for kidney, cardiovascular, and bone dysfunction. Toxins 10, 202 (2018).
The authors are members of the European Renal Nutrition (ERN) Working Group, an initiative of and supported by the European Renal Association–European Dialysis Transplant Association (ERA–EDTA). Further information on this Working Group and its activities can be found at https://www.era-edtaworkinggroups.org/en-US/group/european-renal-nutrition. A.G.O. was supported by The National Council of Science and Technology (CONACYT), CVU 373297, School of Medicine, Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud. J.J.C. acknowledges support from the Swedish Research Council (grant number 2019-01059) and the Swedish Heart and Lung Foundation.
J.J.C. has received consultation, speaker fees or research funding from Abbott, Nutricia, Dr Schär, Laboratorios Rubio, Baxter, AstraZeneca, ViforPharma, Astellas, Novartis and MSD, all outside the submitted work. P.C. is advisory board member at Fresenius Kabi. V.B. acknowledges speaker honoraria from Shire and Fresenius Kabi. P.M. acknowledges consultation or speaker honoraria from Abbott Nutrition, Amgen, Nutricia, Palex and ViforPharma, all outside the submitted work. S.S. acknowledges speaker honoraria from Sanofi Aventis and Abbie. D.F. received honoraria from Fresenius Medical Care, Fresenius Kabi, Sanofi and Vifor. A.C. received speaker honoraria from Shire, Fresenius Kabi, Vifor and Dr Shär. A.E.-C. acknowledges speaker honoraria from Abbott Laboratories and AbbVie. C.C. has received consultation honoraria, advisory board membership or research funding from the Ontario Ministry of Health, Sanofi, Johnson & Johnson, Pfizer, Leo Pharma, Astellas, Janssen, Amgen, Boehringer-Ingelheim and Baxter outside the submitted work. The other authors report no conflicts of interest.
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- Vegan diet
A diet that excludes meat, fish, seafood, eggs and dairy.
- Vegetarian diets
Diets that exclude meat, fish and seafood, but not eggs or dairy.
- Dietary Approaches to Stop Hypertension
(DASH). A diet that was designed to help treat or prevent hypertension. This diet encourages reduced sodium consumption and increased intake of potassium, calcium and magnesium through the high consumption of fruit, vegetables, legumes and nuts and low consumption of meat, fish, seafood, eggs and dairy.
- Mediterranean diet
A traditional diet from countries surrounding the Mediterranean sea that emphasizes large numbers of servings of fruit, vegetables, legumes, nuts, olive oil and fish, and low numbers of servings of meat, seafood, eggs, dairy and processed food (including bread and pastries).
- Okinawan diet
A traditional diet from the island of Okinawa in Japan, which has a population with exceptional longevity. This diet is low in calories and fat and high in carbohydrates. It emphasizes vegetables and soy products alongside occasional, and small, amounts of noodles, rice, pork and fish.
- Healthy eating diet
A diet that exemplifies the US recommended dietary targets 2015–2020. This diet emphasizes fruits, vegetables, whole grains and fat-free or low-fat milk and milk products. It includes lean meats, poultry, fish, beans, eggs and nuts. It is low in saturated fats, trans fats, cholesterol, salt (sodium) and added sugars, and stays within daily calorie needs.
- Essential amino acids
Amino acids that cannot be synthesized by an organism from other nitrogen sources.
- Interdialytic weight gain
Change in body weight between two dialysis sessions. It is routinely assessed and used together with clinical symptoms and signs and predialysis blood pressure readings to make decisions regarding the amount of fluid removal during a dialysis session. It is also used as a basis for fluid and salt intake recommendations.
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Carrero, J.J., González-Ortiz, A., Avesani, C.M. et al. Plant-based diets to manage the risks and complications of chronic kidney disease. Nat Rev Nephrol 16, 525–542 (2020). https://doi.org/10.1038/s41581-020-0297-2
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