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Plant-based diets in patients with chronic kidney disease

Wannasit Wathanavasin
Wannasit Wathanavasin
, 
Piyawan Kittiskulnam
Piyawan Kittiskulnam
 and 
Kirsten L. Johansen
Kirsten L. Johansen
   | Mar 20, 2024
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Article Category: Review
Published Online: Mar 20, 2024
Page range: 2 - 10
DOI: https://doi.org/10.2478/abm-2024-0002
Keywords
© 2024 Wannasit Wathanavasin et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

The plant-based dietary spectrum. From left (less flexible) to right (more flexible): vegan diet (including only plant-based items), lacto-vegetarian diet (excluding meat, fish, or poultry but including dairy), ovo-vegetarian diet (excluding meat, fish, or poultry but including eggs), lacto-ovo-vegetarian diet (excluding meat, fish, or poultry but including dairy and eggs), pescatarian diet (excluding meat or poultry but including fish) and omnivorous diet (containing all food groups).
The plant-based dietary spectrum. From left (less flexible) to right (more flexible): vegan diet (including only plant-based items), lacto-vegetarian diet (excluding meat, fish, or poultry but including dairy), ovo-vegetarian diet (excluding meat, fish, or poultry but including eggs), lacto-ovo-vegetarian diet (excluding meat, fish, or poultry but including dairy and eggs), pescatarian diet (excluding meat or poultry but including fish) and omnivorous diet (containing all food groups).

Figure 2.

Effects of plant foods on serum potassium level, including potassium bioavailability, shift and loss. GI, gastrointestinal; K+, potassium.
Effects of plant foods on serum potassium level, including potassium bioavailability, shift and loss. GI, gastrointestinal; K+, potassium.

Figure 3.

Concept of protein restriction in CKD stages 3–5, focusing on both protein quantity, low-protein diet (0.6–0.8 g/kg/d) in order to slow down the CKD progression, and protein quality, plant-compared to animal-based protein in managing CKD-related complications. Adapted from [82]. CKD, chronic kidney disease.
Concept of protein restriction in CKD stages 3–5, focusing on both protein quantity, low-protein diet (0.6–0.8 g/kg/d) in order to slow down the CKD progression, and protein quality, plant-compared to animal-based protein in managing CKD-related complications. Adapted from [82]. CKD, chronic kidney disease.

Overview of plant vs animal foods for management of CKD-related complications

CKD-related complications Animal foods Plant foods
Metabolic acidosis Worsen Improve
(high non-volatile acid load) (high contents of citrate and malate)
Hyperphosphatemia Worsen Improve
(high phosphate bioavailability) (low phosphate bioavailability)
Uremic toxins Likely worsen Likely improve
(harbors proteolytic bacteria) (harbors saccharolytic bacteria)
Inflammation Likely worsen Likely improve
(low antioxidants and no fiber) (high antioxidants and fiber)
Hypertension - Improve
(high potassium and nitrate content)
Hyperkalemia Less likely to cause hyperkalemia Less likely to cause hyperkalemia
(usually low K+ contents if unprocessed foods) (high K+ contents but increase bowel movement and K+ excretion)

PDCAAS/DIAAS for animal- vs plant-based isolated protein and food

Food PDCAAS DIAAS Limiting amino acids
Animal-based protein
Milk protein concentrate 1.00 1.18 Met + Cys
Whole milk 1.00 1.14 Met + Cys
Egg (hard boiled) 1.00 1.13 His
Chicken breast 1.00 1.08 Trp
Ground Beef (cooked) 0.92 0.99 Leu
Plant-based protein
Soy protein isolate 0.98 0.90 Met + Cys
Pea protein isolate 0.89 0.82 Met + Cys
Cooked rice 0.62 0.59 Lys
Tofu 0.70 0.97 Met + Cys
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