Dietary interventions to improve outcomes in chronic kidney disease.

PURPOSE OF REVIEW: Chronic kidney disease (CKD) is a major epidemic which has global outcomes with increased morbidity and mortality. Given the global implications of CKD, interventions that target modifiable risk factors for CKD are needed. Despite the effectiveness of kidney protection strategies such as hypertension and lipid control as well as the use of antiangiotensin II drugs, the nephropathy in many patients with CKD and reduced glomerular filtration rate (GFR) nevertheless continues to progress toward complete kidney failure. More concerning, CKD-related deaths and in years of life lost due to CKD continue to increase. In this article, we will explore the dietary interventions that recent small-scale studies support slowing the progression of CKD.

RECENT FINDINGS: Dietary acid reduction with Na-based alkali has been shown to be an effective kidney protection strategy for CKD patients with reduced GFR. In addition, recent analyses support diet as the largest CKD-related death and disability risk factor. Small-scale studies show that diets which emphasize ingestion of plant-sourced protein more than animal-sourced protein reduce dietary acid, improve metabolic acidosis, and slow further nephropathy progression in patients with CKD and reduced GFR.

SUMMARY: Dietary interventions are underused as kidney protection strategies. As further studies better define how to best use these dietary interventions for kidney protection, clinicians must become aware of their potential utility in the management of CKD patients.