Lower risk of developing CKD

• In a study of 11,000 patients, those with the highest vegetable protein intake had a 24% lower risk of CKD(Haring). 

• In a cross-sectional study of 5,000 patients, those with the highest animal protein intake had a 37% higher risk of CKD (Joshi Guide).

Lower mortality of CKD

• In a meta-analysis of 6 prospective studies of 14,000 patients, a plant predominant healthy eating pattern was associated with a 27% lower risk of mortality (Kelly). 

Lower risk of excess protein intake 

• Plant based diets tend to be avoid protein excess

• Wide variety of plants provides recommended protein intake for CKD (Joshi, Guide) 

More fiber, less metabolic acidosis and toxins

• Increased fiber with whole plant foods results in less constipation, and facilitates excretion of uremic toxins and dietary potassium (Dupuis and Sirich)

• In a 138 patient cross-sectional study,, vegetarian patients had 47-67% lower levels of uremic toxins(Dupuis Review and Kandouz)

• Plant based foods have natural alkali 

• RCT of 108 patients with CKD; 3 cups of fruit and vegetables daily=oral sodium bicarb to treat metabolic acidosis (Joshi, Guide and check orig ref. Goraya)

Reconsider dietary restriction of potassium and phosphorus in CKD

• ** find executive outcome 

• In 6 experimental studies (n=443) and 3 observational studies (n=8237) whole plant predominant diets did not result in hyperkalemia (except 1 patient with prior history of type IV renal tubular acidosis). Most hyperkalemia from diet is related to intake of juices, sauces, dried fruit or potassium containing salt. (Joshi Guide)

• Plant based foods have lower bioavailability of phosphorus

• In a cross-over trial, 1 week of vegetarian diet led to significantly lower serum phosphorus compared to meat diet (Dupuis and Moe)

Lower risk and increase outcomes in those with comorbid diseases

• Diabetes and hypertension account for 70% of cases of kidney failure.

• The main driver of increased morbidity and mortality in CKD is excess cardiovascular risk.

• Plant  predominant diets improve diabetes (Barnard), hypertension (DASH results) and cardiovascular disease (Ornish) and also reduce the risk of cancer and Alzheimer's disease

Better for environment 

• 26% of greenhouse gases come from food production, and most of this is from beef and dairy. (Our World in Data)

KDIGO executive conclusions

• Increasing evidence to show beneficial associations with plant based diets in CK

• Paucity of data on effect of dietary modification in restoring abnormal serum potassium to the normal range

• Suggests a Paradigm Shift from the idea of dietary restriction TO dietary patterns associated with better outcomes (plant predominant diets)