Plant-Dominant Low Protein Diet: A Potential Alternative Dietary Practice for Patients with Chronic Kidney Disease

Dietary protein restriction has long been a cornerstone of nutritional therapy for patients with chronic kidney diseases (CKD). However, the recommended amount of dietary protein intake is different across guidelines. This is partly because previous randomized controlled trials have reported conflicting results regarding the efficacy of protein restriction in terms of kidney outcomes. Interestingly, a vegetarian, very low protein diet has been shown to reduce the risk of kidney failure among patients with advanced CKD, without increasing the incidence of hyperkalemia. This finding suggests that the source of protein may also influence the kidney outcomes. Furthermore, a plant-dominant low-protein diet (PLADO) has recently been proposed as an alternative dietary therapy for patients with CKD. There are several potential mechanisms by which plant-based diets would benefit patients with CKD. For example, plant-based diets may reduce the production of gut-derived uremic toxins by increasing the intake of fiber, and are useful for correcting metabolic acidosis and hyperphosphatemia. Plant proteins are less likely to induce glomerular hyperfiltration than animal proteins. Furthermore, plant-based diets increase magnesium intake, which may prevent vascular calcification. More evidence is needed to establish the efficacy, safety, and feasibility of PLADO as a new adjunct therapy in real-world patients with CKD.

Automated summary

Dietary protein restriction has long been practiced in the nutritional therapy of chronic kidney diseases (CKD), but the recommended amounts vary across guidelines due to conflicting results from previous trials. Recent studies have shown that a vegetarian, very low protein diet can reduce the risk of kidney failure among advanced CKD patients without increasing hyperkalemia. Plant-dominant low-protein diets (PLADO) are proposed as an alternative therapy for CKD patients, offering several potential benefits such as reducing toxin production, correcting metabolic imbalances, and preventing vascular calcification. However, further evidence is needed to establish the efficacy, safety, and feasibility of PLADO in real-world CKD patients.