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• W3036945312 abstract "Whole-food, low-protein, plant-based diets can be both nutritionally adequate and provide benefit to treat patients with chronic kidney disease (CKD) who desire to delay or avoid dialysis and maintain wellness. While the precise amount of protein should be determined with a registered dietitian, low protein is typically defined as 0.6-.75 g per kilogram of body weight or 0.3 g per kilogram of body weight with supplementation. Several explanations exist to describe the benefit of this approach. Furthermore, patients will likely adhere to this eating pattern if they have clear goals and beliefs that the prescribed diet may help them with their health. Contrary to higher protein intake, low-protein diets, particularly plant protein, decrease intraglomerular pressure thus lowering proteinuria. Reduction in uremic, nitrogenous waste that causes poor appetite and increased workload on the kidneys denotes an additional benefit of protein restriction.1Piccoli G. Capizzi I. Vigotti F. et al.Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?.BMC Nephrol. 2016; 17: 76Crossref PubMed Scopus (35) Google Scholar,2Kalantar-Zadeh K. Foque D. Nutritional management of chronic kidney disease.N Engl J Med. 2017; 377: 1765-1776Crossref PubMed Scopus (233) Google Scholar Before the widespread accessibility of dialysis in developed nations, low-protein diets served as the treatment of choice.3Joshi S. Shah S. Kalantar-Zadeh K. Adequacy of plant-based proteins in chronic kidney disease.J Ren Nutr. 2019; 29: 112-117Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar While conflicting opinions now exist on this therapy because of the Modification of Diet in Renal Disease (MDRD) trial, numerous trials succeeding MDRD as well as meta-analyses of the MDRD trial confirm the beneficial effect of lowering dietary protein to treat CKD.4Ko G. Obi Y. Tortorici A. Kalantar-Zadeh K. Dietary protein intake and chronic kidney disease.Curr Opin Clin Nutr Metab Care. 2017; 20: 77-85Crossref PubMed Scopus (83) Google Scholar Common in patients with CKD, chronic, low-grade inflammation plays a role in CKD progression as well as a decline in overall health.5Mihai S. Codrici E. Popescu I. et al.Inflammation-related mechanisms in chronic kidney disease prediction, progression, and outcome.J Immunol Res. 2018; 2018: 1-16Crossref Scopus (135) Google Scholar Fruits, vegetables, and legumes contain high levels of antioxidants and phytochemicals that mediate this inflammatory state.6Wallace T. Bailey R. Blumberg J. et al.Fruits, vegetables, and health: a comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake.Crit Rev Food Sci Nutr. 2019; : 31-38PubMed Google Scholar Animal protein, especially when processed or exposed to high-temperature cooking, is subject to oxidation thereby generating reactive oxygen species, and chemical toxins; both of which contribute to inflammation.7Jiang J. Xiong Y. Natural antioxidants as food and feed additives to promote health benefits and quality of meat products: a review.Meat Sci. 2016; 120: 107-117Crossref PubMed Scopus (230) Google Scholar Bone mineral metabolism derangements increase as kidney disease progresses leading to poor bone health and increased cardiovascular disease (CVD) risk. One may not observe elevated phosphorus levels before dialysis, although some do. However, fibroblast growth factor (FGF-23), a phosphaturic hormone, will likely increase. Phosphorus in plants is stored in the form of phytate. Humans do not express the enzyme phytase necessary to break down and absorb this form. Thus, less than 50% of the phosphorus from plants will be absorbed, improving levels in patients with CKD. In turn, FGF-23 levels are also lower when the percentage of protein from plants is higher in the diet. While FGF-23 increases urinary excretions of phosphorus to maintain normal levels, as FGF elevates, so does arterial stiffness, endothelial dysfunction, left ventricular mass, and progression of CKD.8Stöhr R. Schuh A. Heine G. Brandenburg V. FGF23 in cardiovascular disease: innocent bystander or active mediator?.Front Endocrinol (Lausanne). 2018; 9: 351Crossref PubMed Scopus (24) Google Scholar, 9Russo D. Battaglia Y. Clinical significance of FGF-23 in patients with CKD.Int J Nephrol. 2011; 2011: 1-5Crossref Google Scholar, 10Scialla J. Appel L. Wolf M. 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. 2012; 22: 379-388.e1Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar Acidosis in patients with CKD has been linked to low albumin levels, muscle wasting, bone derangements, and progression of disease.11Kraut J. Madias N. Metabolic acidosis of CKD: an update.Am J Kidney Dis. 2016; 67: 307-317Abstract Full Text Full Text PDF PubMed Scopus (122) Google Scholar Sulfate-containing amino acids, abundant in animal protein, contribute to the patient's acid load. By contrast, plant-based proteins, more alkaline, are associated with higher serum bicarbonate levels in patients with CKD.10Scialla J. Appel L. Wolf M. 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. 2012; 22: 379-388.e1Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar Evidence supports prevention, treatment, and reversal of the major comorbidities associated with CKD; diabetes, hypertension, and CVD. Whole plant food intake to prevent and treat diabetes has been shown in numerous meta-analysis and observational studies.12Lee Y. Park K. Adherence to a vegetarian diet and diabetes risk: a systematic review and meta-analysis of observational studies.Nutrients. 2017; 9: 603Crossref Scopus (41) Google Scholar,13McMacken M. Shah S. A plant-based diet for the prevention and treatment of diabetes.J Geriatr Cardiol. 2017; 14: 342-354PubMed Google Scholar Diets rich in meat have been shown to increase intracellular lipid storage which leads to insulin resistance.14Barnard N. Levin S. Trapp C. Meat consumption as a risk factor for type 2 diabetes.Nutrients. 2014; 6: 897-910Crossref PubMed Scopus (46) Google Scholar Thus, other meta-analysis revealed associations with diabetes and intake of red and processed meat. This was after adjustments were made for saturated fat, total fat intake, and BMI.13McMacken M. Shah S. A plant-based diet for the prevention and treatment of diabetes.J Geriatr Cardiol. 2017; 14: 342-354PubMed Google Scholar A meta-analysis of seven controlled trials and 32 observational studies revealed that plant-based diets are associated with lower blood pressure when compared with omnivorous diets.15Yokoyama Y. Nishimura K. Barnard N. et al.Vegetarian diets and blood pressure.JAMA Intern Med. 2014; 174: 577Crossref PubMed Scopus (241) Google Scholar Review of the Nurses' Health Study showed lower CVD mortality with the inclusion of more vegetable protein as opposed to animal protein which had an increase in CVD mortality.16Fung T. Low-carbohydrate diets and all-cause and cause-specific mortality.Ann Intern Med. 2010; 153: 289Crossref PubMed Scopus (220) Google Scholar In addition, Dean Ornish's famous Lifestyle Heart Trial revealed that 82% of patients following his plant-based program not only halted atherosclerosis but actually regressed the disease.17Ornish D. Intensive lifestyle changes for reversal of coronary heart disease.JAMA. 1998; 280: 2001Crossref PubMed Scopus (1070) Google Scholar In addition to traditional CVD risk factors, patients with CKD have bone mineral derangements leading to poor CVD outcomes. Trimethylamine N-oxide, produced by the gut microbiota, denotes a newer factor in not only the development of CVD in patients with CKD but also a kidney toxin. Interestingly, those who consume a plant-based diet possess a gut microbiota that will not convert animal-based foods to trimethylamine N-oxide.18Tuso P. A plant-based diet, atherogenesis, and coronary artery disease prevention.Perm J. 2015; 19: 62-67Crossref PubMed Scopus (62) Google Scholar Adherence and acceptability of plant-based diets has been shown in numerous studies, across many years, among varied patient populations.19Barnard N. Cohen J. Jenkins D. et al.A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial.Am J Clin Nutr. 2009; 89: 1588S-1596SCrossref PubMed Scopus (236) Google Scholar, 20Barnard N. Scherwitz L. Ornish D. Adherence and acceptability of a low-fat, vegetarian diet among patients with cardiac disease.J Cardiopulm Rehabil. 1992; 12: 423-431Crossref Scopus (29) Google Scholar, 21Barnard N. Scialli A. Bertron P. Hurlock D. Edmonds K. Acceptability of a therapeutic low-fat, vegan diet in premenopausal women.J Nutr Educ. 2000; 32: 314-319Abstract Full Text PDF Google Scholar However, when patients and practitioners align in shared decision-making toward a common goal, adherence and success is more likely. Consistent follow-up also increases the likelihood of success.22Karlsen M. Pollard K. Strategies for practitioners to support patients in plant-based eating.J Geriatr Cardiol. 2017; 14: 338-341PubMed Google Scholar For the efforts of this discussion, slowing the path or avoiding dialysis and maintaining wellness characterizes the goal of the CKD stages 1-5 population. Plant-based diets low in protein provide a clear conduit to achieve this end as evidenced by numerous studies. Whole-food, low-protein, plant-based diets provide a healthy option for patients with damaged kidneys. Not only does this approach provide hope for patients wishing to delay or avoid dialysis, but also it aids with comorbid conditions that contribute to decline in overall health. The attached handout on whole-food, low-protein, plant-based diets can be used with your patients with CKD 1-5 not yet on dialysis." @default.
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• W3036945312 title "Whole-Food Low-Protein Plant-Based Nutrition to Prevent or Slow Progression of Chronic Kidney Disease" @default.
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