Plant-based diets in kidney disease management

As our awareness of chronic kidney disease (CKD) rolls over into a new era of bundling, improved treatment options, and medicinal choices, so our knowledge of nutrition and its impact on disease management also evolves. For decades, vegetarianism and kidney disease has been seen as an oil-and-water amalgamation. Dietitians have been challenged to align diet recommendations with vegetarian-type diets. Dietitians may struggle with concerns that more plant-based diets would be lacking in protein or would be high potassium and phosphorus. However, just as we have advanced in our understanding of so many aspects of kidney disease, we can now appreciate that a plant-based diet can work to our patient's advantage and, by learning these advantages, feel more comfortable with working these foods into patient meal planning.

Although studies are small, several support the idea that plant-based diets can delay the progression of CKD, provide endothelial protection, control high blood pressure, and decrease proteinuria.1-10 These days, our dialysis patients seldom die secondary to high potassium or uremia. Many of our patients now face the same diseases as the general population: heart disease, cancer, and strokes.11 A plant-based diet provides nutrients that not only assist in kidney disease management but also can provide an edge of protection against costly, debilitating complications.8

In a poll conducted by the Vegetarian Resource Group in 2009, it was found that 3% of American adults did not eat red meat, fish, or poultry, and a third of those did not eat dairy, eggs, or honey. The same survey found that 8% of American adults did not eat red meat. As a result, the chances of having a patient who chooses to eat vegetarian based on preference may be low, and a dietician may choose to encourage plant-based options for beneficial health reasons. This includes preventing the co-morbid conditions associated with kidney disease, kidney disease progression, or possibly kidney disease itself.