Table 2.
Summary of Studies Investigating the Potential Benefits of a Plant-Based Diet in CKD Outcomes
| Study | Design (mean or median follow-up) | Population (n) | Parameter(s) Studied | CKD Outcome |
|---|---|---|---|---|
| ARIC Study30 | Prospective cohort (24 y) | Age 45-64 y, eGFR ≥ 60 mL/min/1.73 m2 at baseline (n = 14,686) | Overall plant-based diet, healthy plant-based diet, and less healthy plant-based diet | Lower risk for incident CKDa and slower annual eGFR decline with highest intake of overall and healthy plant-based diets |
| CRIC Study36 | Prospective cohort (4 y) | Age 21-74 y, eGFR 20–70 mL/min/1.73 m2 at baseline (n = 3,939) | Lifestyle factors: regular physical activity, BMI, nonsmoking, and healthy diet | No significant association between healthy diet and CKD progression |
| Jhee et al,31 2019 | Prospective cohort study (8.2 y) | Age 40-69 y, eGFR ≥ 60 mL/min/1/73 m2 at baseline (n = 9,229) | Daily consumption of fruit and vegetables (nonfermented or fermented) | Lower risk for incident CKDa with highest vs lowest intake of nonfermented vegetables, but no significant risk reduction with any level of intake of fermented vegetables or fruits |
| Northern Manhattan Study32 | Prospective cohort study (6.9 y) | Age > 40 y, eGFR ≥60 mL/min/1.73 m2 at baseline (n = 803) | MeDi score (< 5 vs ≥ 5)b | Lower odds of incident CKDa with MeDi score ≥ 5 vs < 5 |
| Singapore Chinese Health Study33 | Prospective cohort study (15.5 y) | Age 45-74 y, eGFR ≥ 15 mL/min/1.73 m2 (n = 60,198) | Red meat vs other protein sources | Dose-dependent increase in risk for ESKD with red meat intake; risk reduction when daily red meat replaced with other protein |
| Goraya et al,37 2014 | Randomized interventional study (3 y) | Age ≥ 18 y, nondiabetic stage 3 CKD (eGFR 30-50 mL/min/1.73 m2) with metabolic acidosis (n = 108) | Fruit + vegetables, oral NaHCO3, or usual care (no alkali therapy) | Reduced urine excretion of angiotensinogen and slower rates of eGFR decline with fruit + vegetables or NaHCO3 vs usual care |
| REGARDS Study38 | Prospective cohort study (6.4 y) | Age ≥ 45 y, eGFR < 60 mL/min/1.73 m2 (n = 6,009) | Dietary patterns: convenience, plant-based, sweets/fat, Southern, alcohol/salads | No significant association between risk for ESKD and convenience, plant-based, sweets/fat, or alcohol/salads dietary patterns |
| Satirapoj et al,39 2018 | Retrospective cohort study (1 y) | Age ≥ 18 y, nondialysis stages 3-4 CKD (eGFR 15-59 mL/min/1.73 m2) (n = 140) | Very low-protein diet + KA/EAA vs low-protein diet | Significantly slower rate of eGFR decline with very low-protein diet + KA/EAA vs low-protein diet |
Abbreviations: ARIC, Atherosclerosis Risk in Communities; BMI, body mass index; CKD, chronic kidney disease; CRIC, Chronic Renal Insufficiency Cohort; eGFR, estimate glomerular filtration rate; ESKD, end-stage kidney disease; KA/EAA, ketoacid analogues of essential amino acids; MeDi, Mediterranean Diet; NaHCO3, sodium bicarbonate; REGARDS, Reasons for Geographic and Racial Differences in Stroke.
a
Defined as incident occurrence of eGFR < 60 mL/min/1.73 m2.
b
MeDi score ranged from 0 to 9, with higher scores representing closer similarity to a Mediterranean diet.