Diet as a treatment for chronic kidney disease

Abstract

The management of chronic kidney disease (CKD) includes nutritional interventions aimed at slowing disease progression and mitigating complications. This review examines various dietary approaches for CKD treatment, focusing on carbohydrate intake modulation, ketogenic diets, and plant-based diets. Standard guidelines recommend carbohydrate intake within 45% to 65% of total calories, but there is growing interest in reducing carbohydrate consumption to preserve kidney function. Low-carbohydrate diets (<25% of total calories) have shown benefits in glycemic control and weight reduction but may pose long-term adherence challenges. High-protein, low-carbohydrate diets are discouraged due to associations with hyperfiltration and CKD progression. Limiting fructose intake has been linked to reductions in blood pressure and uric acid levels. Intermittent fasting and ketogenic diets, which promote ketone body production and reduce inflammation, have shown promise in animal models and some human studies, particularly in autosomal dominant polycystic kidney disease, though more research is needed. Plant-based diets, such as the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, offer cardiovascular benefits and may reduce CKD risk but require careful management of potassium intake. Overall, dietary interventions should be individualized, considering potential risks like hyperkalemia and ensuring nutritional adequacy.

Keywords

• carbohydrate-restricted diets
• children
• chronic renal insufficiency
• ketogenic diets
• plant-based diets