Table 2.

Interventional studies analyzing the effect of plant protein or plant-based dietary pattern on CKD complications.

Study	Type	Intervention /Assessment	Population	Follow Up	Outcomes	Results/Comments
INTERVENTIONAL STUDIES
Fanti et al. 2006 [30]	Randomized controlled trial	Isoflavone-containing soy-based nutritional supplements (soy group) or isoflavone-free milk protein (control group)	n = 25 ESKD on chronic hemodialysis with systemic inflammation	8 weeks	Impact on inflammatory markers and nutrition markers	↗ serum isoflavone levels associated with ↘ CRP (HR = −0.599, p = 0.02) and ↗ albumin (HR = 0.522, p < 0.05) No significant decrease of CRP between the two groups but a trend in the soy protein group
Soroka et al. 1998 [31]	Randomized cross-over trial	Plant protein diet versus animal protein diet	n = 9 CKD G3-G4	1 year	eGFR decline	Failed to find a difference between APD versus VPD but it was underpowered and short trial A better degree of compliance with caloric, protein, and phosphate intakes
Tabibi et al. 2009 [32]	Randomized controlled trial	Soy flour (14 g of soy protein) versus usual diet	n = 40 ESKD on peritoneal dialysis	8 weeks	Serum lipid profile	↘ serum Lipoprotein A concentration in the soy protein group (p < 0.05)
Moe et al. 2011 [33]	Cross-over trial	Vegetarian versus meat diet comparison	n = 8 CKD G3-G4	7 days	Impact on phosphorus homeostasis	↘ phosphorus serum concentration (p = 0.02) and ↘ FGF23 (p = 0.008) in the vegetarian diet
Goraya et al. 2013 [34]	Randomized controlled trial	Oral NaHCO3 compared with fruit and plant diet with a controlled arm	n = 106 CKD G4 with metabolic acidosis	1 year	Metabolic acidosis	Fruit and plant diet are as effective as oral bicarbonate to improve metabolic acidosis (19.9 versus 19.3 mM; p= 0.01), without an increase of hyperkaliemia risk.
Goraya et al. 2014 [35]	Randomized controlled trial	Oral NaHCO3 compared with fruit and p diet with a controlled arm	n = 108 CKD G3 A > 1	3 years	Urine excretion of angiotensinogen eGFR decline	Fruit and plant diet are as effective as oral bicarbonate decrease angiotensinogen urine excretion (p < 0.05) and preserve eGFR (p < 0.01) versus usual care
Goraya et al. 2019 [36]	Randomized controlled trial	Oral NaHCO3 compared with fruit and plant diet with a controlled arm	n = 108 CKD G3-4 A > 1 Nondiabetic	5 years	Metabolic acidosis, eGFR decline and CVD risk factors	Fruit and plant diet are as effective as oral bicarbonate to correct metabolic acidosis (p < 0.01), eGFR decline (−10.0, 95% CI −10.6 to −9.4 mL/min/1.73 m2 versus −18.8, 95% CI −19.5 to −18.2 mL/min/1.73 m2 in usual care group), p < 0.01.) and was better than bicarbonate to reduce systolic blood pressure (p < 0.01) It was more effective to lower low-density lipoprotein and increase serum vitamin K1

Only randomized controlled trials were selected in PubMed database. Abbreviations: APD, animal protein diet; CRP: C reactive protein; CVD, Cardiovascular disease; CKD, chronic kidney disease; ESKD, end-stage kidney disease; eGFR, estimated glomerular filtration rate; FGF23, fibroblast growth factor 23; NaHCO3, sodium bicarbonate; VPD, plant protein diet; HR, hazard ratio.