Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

Kamyar Kalantar-Zadeh
* ORCID logo ,
Shivam Joshi
,
Rebecca Schlueter
,
Joanne L. Cooke
ORCID logo ,
Amanda Brown-Tortorici
,
Meghan Donnelly
,
Sherry Schulman
,
Wei Ling Lau
* ORCID logo ,
Connie M. Rhee
,
Elani Streja
,
Ekamol Tantisattamo
ORCID logo ,
Antoney J. Ferrey
,
Ramy S. Hanna
,
Joline L. Chen
,
Shaista Malik
,
Danh V. Nguyen
,
Susan T. Crowley
,
Csaba P. Kovesdy
ORCID logo
Version 1 : Received: 31 May 2020 / Approved: 31 May 2020 / Online: 31 May 2020 (21:22:42 CEST)

A peer-reviewed article of this Preprint also exists.

Kalantar-Zadeh, K.; Joshi, S.; Schlueter, R.; Cooke, J.; Brown-Tortorici, A.; Donnelly, M.; Schulman, S.; Lau, W.-L.; Rhee, C.M.; Streja, E.; Tantisattamo, E.; Ferrey, A.J.; Hanna, R.; Chen, J.L.; Malik, S.; Nguyen, D.V.; Crowley, S.T.; Kovesdy, C.P. Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease. Nutrients 2020, 12, 1931. Kalantar-Zadeh, K.; Joshi, S.; Schlueter, R.; Cooke, J.; Brown-Tortorici, A.; Donnelly, M.; Schulman, S.; Lau, W.-L.; Rhee, C.M.; Streja, E.; Tantisattamo, E.; Ferrey, A.J.; Hanna, R.; Chen, J.L.; Malik, S.; Nguyen, D.V.; Crowley, S.T.; Kovesdy, C.P. Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease. Nutrients 2020, 12, 1931.

Abstract

Chronic kidney disease (CKD) affects >10% of the adult population. Each year approximately 120,000 Americans develop end-stage kideny disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6-0.8 g/kg/day comprised of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, can be promising. The scientific premise of the PLADO is based on the observations that high protein diets with high meat intake are not only associated with higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of hyperkalemia, given constipation from the typical low fiber intake. Plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk in CKD patients. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

Keywords

Plant-dominant diet; low-protein diet; dietary protein intake; glomerular hyperfiltration; CKD prevention; uremia

Subject

Medicine and Pharmacology, Dietetics and Nutrition

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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