Introduction

Kidney disease is a significant public health concern, affecting millions of people worldwide. Proper management of kidney disease involves a comprehensive approach that includes medication, lifestyle changes, and, critically, diet and nutrition. The kidneys play a vital role in filtering waste products, excess fluids, and toxins from the blood, maintaining electrolyte balance, and regulating blood pressure. When kidney function is compromised, these processes are disrupted, leading to the accumulation of waste products and fluid in the body, which can have serious health consequences. Dietary and nutritional management are essential components of preventing, managing, and slowing the progression of kidney disease.

What are the nutritional requirements for kidney disease?

Diet plays a crucial role in managing kidney disease, particularly in preventing the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD), where dialysis or kidney transplantation may become necessary. A well-planned diet can help reduce the burden on the kidneys by controlling the intake of certain nutrients that can be harmful when kidney function is impaired.

• A recommended eating plan is a diet rich in whole fresh seasonal foods, to help maintain good kidney health. This includes vegetables and wholegrains, and foods tailored to culture and spirituality. The recommendation is to limit ultra-processed foods and salt.
• Is plant-based better than protein based diet? Plant-based protein options often contain more fiber than animal proteins, which can provide additional health benefits. Experts recommend that at least some plant-based protein, like beans, are included into the diet, as well as focusing on lean animal protein like fish or chicken. In other words, the idea of a plant-based diet is to make plant-based foods the central part of your meals. 
• What is the downside of a plant-based diet? A number of studies have shown that those on a plant-based diet are found to have lower plasma vitamin B12 levels and higher levels of vitamin B12 deficiency than those who consume animal products. Vitamin B12 is an important cofactor in DNA synthesis, and deficiency can lead to anemia and severe neurological dysfunction. In other words, a primary concern with plant-based protein sources is the incomplete amino acid profile. Unlike animal-based protein sources, which provide all essential amino acids, most plant proteins lack one or more essential amino acids.
• Does plant protein stress kidneys? There is an opinion that healthy people on vegetarian diets have significantly lower levels of creatinine than people who eat both meat and vegetables. Creatinine is a waste product from a person’s muscles.

There are several health benefits to following a plant-based diet:

• A reduced risk of type 2 diabetes: In one review, researchers found that following a plant-based diet was associated with a lower risk of type 2 diabetes.
• A healthier weight and blood sugar level in people with diabetes: A plant-based diet may be beneficial for boosting metabolism, managing weight, and reducing inflammation, especially among people with obesity and those with type 1 and type 2 diabetes.
• A reduced risk of heart disease: Studies have linked following a diet rich in plant foods and lower in animal foods to a 16 percent lower risk of cardiovascular disease and 31 to 32 percent lower risk of death from cardiovascular disease.
• A reduced risk of cancer: One study showed that people who ate low quantities of meat and fish had a lower risk of colorectal, breast, and prostate cancer compared to study participants who ate larger amounts of meat and fish. Another study focused on breast cancer specifically and found that individuals who most closely followed a plant-based diet had 67 percent lower risk of breast cancer than those who followed it the least.
• A healthier brain: While research is mixed, one study involving more than 3,000 adults found that sticking with a plant-based diet was linked with better cognitive function, including long-term memory and executive function, though future research should explore the mechanisms behind why this happens.
• A longer life: Some research links a diet containing higher levels of plant protein with a lower rate of early death from all causes. One study of 135,000 individuals found a link between increased intake of fruits, vegetables, and legumes and a lower risk of all-cause early death, with participants reaping maximum health benefits at three to four servings per day — an amount that anyone following a plant-based diet is likely to meet.

Challenges with a plant-based diet: Not all ‘plant-foods’ are created equal: Simply sticking with plant-based foods likely isn’t going to cut it. There are plenty of unhealthy foods that qualify as plant-based, such as potato chips and French fries. Unhealthy processed plant-based foods will increase the risk of weight gain and health conditions such as heart disease.

• Bowel movements: When the person/patient first switch to a plant-based diet, there may be an uptick in bowel movements, diarrhea, or constipation. That’s because many plant-based foods are a good source of fiber, and fiber normalizes bowel movements. It is wise to consider gradually incorporating plant-based foods in the diet to give the body time to adjust.  It is most important to drink plenty of fluids while making the switch to eating more plants and afterward.
• Lack of B12 and choline: While many plant-based foods are loaded with nutrients, there are some that are harder to come by if completely eliminate animal food products from the diet. It is important to keep an eye on levels of vitamin B12 and choline. Vitamin B12 is found primarily in animal sources, and the two best sources of choline are egg yolks and liver. If a person is avoiding animal products, they may not be taking in enough of these nutrients. Nutritional yeast is a great source of B12 that’s easy to add to many plant-based meals. Legumes, soy, and peanuts are a great source of plant-based choline.

The cost of a Plant-Based Diet

Oat milk or almond milk tend to be pricier than cow’s milk, and it may pay a slight premium for vegan cheese over dairy cheeses as well. On the other hand, plant-based protein sources tend to cost significantly less than meat or fish protein.  

Top 10 Foods to Eat

• Leafy green vegetables (including spinach, Swiss chard, collard greens)
• Cruciferous vegetables (including broccoli, kale, cabbage, cauliflower)
• Root vegetables (including carrots and sweet potatoes)
• Fruits (such as avocados, strawberries, blueberries, watermelon, apples, grapes, bananas, grapefruit, and oranges)
• Whole grains (such as quinoa, farro, brown rice, whole-wheat bread, and whole-wheat pasta)

Quinoa is considered a carbohydrate because it contains many carbs per serving. Although it contains some protein, the macronutrient distribution is closer to what is found in other grains and starches. Though technically a seed, Quinoa is classified as a whole grain and is a good source of plant protein and fiber. One cup cooked provides about 8 grams of protein and 5 grams of fiber.

Farro, sometimes called emmer, can be cooked as one would steam brown rice and added to salads, but is delicious made into farrotto, similar to risotto, or simmered in chicken stock with sautéed carrots and celery to make soup. Spelt is high in protein and quite commonly ground into flour and used in baking. Farro, a high-protein, high-fiber ancient whole-grain wheat, looks similar to barley, though with a slightly more oblong and larger grain. Like barley, farro retains a notable amount of chew when it gets cooked. Farro and barley can be used interchangeably in most recipes. Farro is a wheat product and contains gluten.

Top 10 Foods to Avoid

• Dairy (including milk and cheese), 
• Meat and poultry (like chicken, beef, and pork), 
• Processed animal meats, such as sausages and hot dogs, 
• Fish, 
• Other processed foods (like potato chips, chocolate bars), 
• Eggs, 
• Refined grains (such as “white” foods, like white pasta, rice, and bread), 
• Sweets (like cookies, brownies, and cake), 
• Sweetened beverages, such as soda, and fruit juice; 
• Fried foods

Nutritional Supplements and Counseling

Nutritional supplements may be necessary for individuals with kidney disease, particularly those who have difficulty meeting their nutritional needs through diet alone. Supplements may include vitamins, minerals, and specially formulated renal supplements that provide essential nutrients without excessive amounts of protein, potassium, or phosphorus.

Nutritional Counseling: Working with a registered dietitian who specializes in kidney disease is essential for developing a personalized nutrition plan that addresses the individual’s unique needs, preferences, and medical conditions. Regular counseling and monitoring can help ensure that dietary recommendations are followed and adjusted as needed.

Conclusion

Diet and nutrition play a pivotal role in the management of kidney disease, from preventing its onset to slowing its progression and managing complications. By carefully controlling the intake of protein, sodium, potassium, phosphorus, and other nutrients, individuals with kidney disease can reduce the burden on their kidneys, maintain better overall health, and improve their quality of life. A comprehensive approach that includes dietary management, medication, lifestyle changes, and regular monitoring is essential for optimal kidney health. Collaboration between healthcare providers, dietitians, and patients is crucial in achieving the best outcomes in kidney disease management.