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

作者：Kamyar Kalantar‐Zadeh, Shivam Joshi, Rebecca Schlueter, Joanne Cooke, Amanda Brown-Tortorici, Meghan Donnelly, Sherry Schulman, Wei Ling Lau, Connie M. Rhee, Elani Streja, Ekamol Tantisattamo, Antoney Ferrey, Ramy Hanna, Joline L. Chen, Shaista Malik, Danh V. Nguyen, Susan T. Crowley, Csaba P. Kövesdy · 发表于：Preprints.org · 年份：2020 · DOI：10.20944/preprints202005.0516.v1 · 被引用次数：62 · 研究领域：Dialysis and Renal Disease Management、Agriculture Sustainability and Environmental Impact、Muscle metabolism and nutrition

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 mo...