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Kim H, Rebholz CM. Plant-based diets for kidney disease prevention and treatment. Curr Opin Nephrol Hypertens 2024; 33:593-602. [PMID: 39115418 PMCID: PMC11419939 DOI: 10.1097/mnh.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE OF REVIEW Plant-based diets are associated with a lower risk of hypertension, diabetes, cardiovascular disease, and mortality. Using the most recent evidence, we critically appraised the role of plant-based diets in primary and secondary prevention of chronic kidney disease (CKD) with a focus on key nutritional factors (dietary acid load, phosphorus, potassium, sodium, and fiber). RECENT FINDINGS In healthy individuals, observational studies found that greater intake of plant protein and higher adherence to plant-based diets (overall, healthful, and provegetarian) was associated with a lower risk of CKD. In those with CKD, plant-based diets were associated with a lower risk of mortality, improved kidney function, and favorable metabolic profiles (fibroblast growth factor-23, uremic toxins, insulin sensitivity, inflammatory biomarkers). Only few studies reported nutrient content of plant-based diets. These studies found that plant-based diets had lower dietary acid load, lower or no significant difference in phosphorus and sodium, and higher potassium and fiber. One study reported that vegetarian diets were associated with severe vitamin D deficiency compared to nonvegetarian diets. SUMMARY Plant-based diets provide several benefits for prevention and management of CKD, with little risk for individuals with CKD. Incorporation of vitamin D rich foods in plant-based diets may be helpful.
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Affiliation(s)
- Hyunju Kim
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington School of Public Health, Seattle, Washington
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Shen J, Wang Z, Liu Y, Wang T, Wang XY, Qu XH, Chen ZP, Han XJ. Association of blood urea nitrogen with all-cause and cardiovascular mortality in hyperlipidemia: NHANES 1999-2018. Lipids Health Dis 2024; 23:164. [PMID: 38831466 PMCID: PMC11145831 DOI: 10.1186/s12944-024-02158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Although blood urea nitrogen (BUN) has a crucial impact on many diseases, its effect on outcomes in patients with hyperlipidemia remains unknown. The study aimed to investigate the relationships between BUN levels and all-cause and cardiovascular disease (CVD) mortality in individuals with hyperlipidemia. METHODS This analysis comprised 28,122 subjects with hyperlipidemia from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. The risk of BUN on mortality was evaluated using weighted Cox regression models. Additionally, to illustrate the dose-response association, the restricted cubic spline (RCS) was used. RESULTS During the observation period, 4276 participant deaths were recorded, of which 1206 were due to CVD. Compared to patients with hyperlipidemia in the third BUN quintile, the hazard ratios (HRs) for all-cause mortality were 1.26 (95% CIs: 1.09, 1.45) and 1.22 (95% CIs: 1.09, 1.37) for patients in the first and fifth quintiles of BUN, respectively. The HRs for CVD mortality among patients in the fifth quintile of BUN were 1.48 (95% CIs: 1.14, 1.93). BUN levels were found to have a U-shaped association with all-cause mortality and a linear association with CVD mortality using restricted triple spline analysis. CONCLUSIONS This study revealed that both low and high BUN levels in patients with hyperlipidemia are associated with heightened all-cause mortality. Furthermore, elevated BUN levels are also associated with increased CVD mortality. The findings indicate that patients with hyperlipidemia may face an elevated risk of death if they have abnormal BUN levels.
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Affiliation(s)
- Jing Shen
- Institute of Geriatrics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China
- School of Public Health, Nanchang University, Nanchang, Jiangxi, 330029, China
| | - Zhen Wang
- Institute of Geriatrics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China
- School of Public Health, Nanchang University, Nanchang, Jiangxi, 330029, China
| | - Yong Liu
- School of Public Health, Nanchang University, Nanchang, Jiangxi, 330029, China
| | - Tao Wang
- Institute of Geriatrics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China
| | - Xiao-Yu Wang
- Institute of Geriatrics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China
| | - Xin-Hui Qu
- The Second Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China
| | - Zhi-Ping Chen
- Institute of Geriatrics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China
| | - Xiao-Jian Han
- Institute of Geriatrics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China.
- The Second Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, 330006, P.R. China.
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Wathanavasin W, Kittiskulnam P, Johansen KL. Plant-based diets in patients with chronic kidney disease. ASIAN BIOMED 2024; 18:2-10. [PMID: 38515633 PMCID: PMC10954082 DOI: 10.2478/abm-2024-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Dietary protein restriction has been considered to be a nutritional-related strategy to reduce risk for end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease (CKD). However, there is insufficient evidence to recommend a particular type of protein to slow down the CKD progression. Recently, various plant-based diets could demonstrate some additional benefits such as a blood pressure-lowering effect, a reduction of metabolic acidosis as well as hyperphosphatemia, and gut-derived uremic toxins. Furthermore, the former concerns about the risk of undernutrition and hyperkalemia observed with plant-based diets may be inconsistent in real clinical practice. In this review, we summarize the current evidence of the proposed pleiotropic effects of plant-based diets and their associations with clinical outcomes among pre-dialysis CKD patients.
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Affiliation(s)
- Wannasit Wathanavasin
- Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok10330, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
- Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok10330, Thailand
- Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok10330, Thailand
| | - Kirsten L. Johansen
- Division of Nephrology, Hennepin Healthcare, Minneapolis, MN55415, USA
- Division of Nephrology, University of Minnesota, Minneapolis, MN55415, USA
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Świątek Ł, Jeske J, Miedziaszczyk M, Idasiak-Piechocka I. The impact of a vegetarian diet on chronic kidney disease (CKD) progression - a systematic review. BMC Nephrol 2023; 24:168. [PMID: 37308813 DOI: 10.1186/s12882-023-03233-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/06/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND A vegetarian diet is a popular alternative to the casual diet - it is considered healthy, and was proven to positively affect cardiovascular health. The Chronic Kidney Disease (CKD) progression is a major issue in the healthcare system, and constitutes a leading cause of death for 1.5% of the global population. The objective of this systematic review was to investigate the potential impact of a vegetarian diet on kidney function in CKD patients. METHOD Our systematic review focused on randomized controlled trials (RCTs) which compared the effects of a vegetarian diet (experimental) and a standard omnivore diet (comparator) in terms of the estimated glomerular filtration rate (eGFR) in CKD patients. Inclusion criteria were based on PICO elements, with two researchers involved in browsing the Cochrane and Pubmed search engines. The investigation was performed using the PRISMA 2020 Checklist and PRISMA 2020 flow diagram. The search terms included: 'vegetarian diet' AND 'nephropathy', 'eGFR', 'albuminuria', 'chronic kidney disease'. Bias assessment was performed using RoB 2 tool to determine the validity of the data collected from studies. RESULTS Four RCTs with a total of 346 participants were included in the presented systematic review. Two largest RCTs reported an increase in eGFR following a change to a vegetarian diet (p = 0.01 and p = 0.001). Another two found no significant differences between the experimental and control groups, also these trials were associated with a high risk of bias in terms of missing data outcome and the randomization process. CONCLUSIONS The findings collected in this systematic review suggest that a vegetarian diet improves renal filtration function in CKD patients. Therefore, it seems essential to conduct further research involving the impact of the diet on the progression of CKD.
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Affiliation(s)
- Łukasz Świątek
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
| | - Jan Jeske
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Miłosz Miedziaszczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ilona Idasiak-Piechocka
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Xu Y, Mo G, Yao Y, Li C. The effects of vegetarian diets on glycemia and lipid parameters in adult patients with overweight and obesity: a systematic review and meta-analysis. Eur J Clin Nutr 2023:10.1038/s41430-023-01283-x. [PMID: 36964271 DOI: 10.1038/s41430-023-01283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
Several randomized controlled trials have reported the effects of vegetarian diets on blood lipids and glucose homeostasis in adults, but not in overweight or obese individuals. Thus, the purpose of this study was to evaluate the effects of vegetarian diets on blood lipids and glucose homeostasis in overweight or obese adults by systematic review and meta-analysis. We searched Medline, Embase, and the Cochrane Library through October 2021. We chose to include overweight or obese patients in the studies of the vegetarian diet for metabolic control. Seven trials with a total of 783 overweight or obese adult were included in the meta-analysis. The analysis of the data revealed that the vegetarian diets significantly reduced low-density lipoprotein cholesterol (LDL-C) (WMD, -0.31; 95% CI, -0.46 to -0.16), total cholesterol (TC) (WMD, -0.37; 95% CI, -0.52 to -0.22), and HbA1c (WMD (%), -0.33; 95% CI, -0.55 to -0.11). The vegetarian diets had an elevated effect on blood triglycerides (WMD, 0.29; 95% CI, 0.11-0.47). However, there were no significant effects of vegetarian diets on high-density lipoprotein cholesterol (HDLC), Fasting plasma glucose(FPG), and HOMA-IR in these individuals. The results of this study suggest that vegetarian diets effectively reduce LDL-C, TC, and HbA1c levels, thus functioning as a promising therapeutic strategy for improving the metabolic dysfunction in overweight or obese individuals. However, further large-scale clinical trials are required to confirm the validity of these findings.
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Affiliation(s)
- Yang Xu
- The First College for Clinical Medicine, Guangxi Medical University, Guangxi, China
| | - Guli Mo
- The First College for Clinical Medicine, Guangxi Medical University, Guangxi, China
| | - Yu Yao
- The First College for Clinical Medicine, Guangxi Medical University, Guangxi, China
| | - Chuan Li
- Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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Pieczyńska K, Rzymski P. Health Benefits of Vegetarian and Mediterranean Diets: Narrative Review. POL J FOOD NUTR SCI 2022. [DOI: 10.31883/pjfns/156067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bartholomae E, Knurick J, Johnston CS. Serum creatinine as an indicator of lean body mass in vegetarians and omnivores. Front Nutr 2022; 9:996541. [PMID: 36185683 PMCID: PMC9525150 DOI: 10.3389/fnut.2022.996541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022] Open
Abstract
Growing numbers of Americans are adopting vegetarian or vegan diets. While risk for some chronic conditions may be lower when following these diets, concern remains over the ability to consume adequate amounts of various nutrients, notably, protein. Knowing that serum creatinine is a reliable marker of muscle mass, this study examined the relationships between serum creatinine, lean body mass (LBM), handgrip strength, and protein intake in healthy vegetarian (n = 55) and omnivorous (n = 27) adults. Significantly higher protein intakes (+31%), LBM (+7%), serum creatinine (+12%) and handgrip strength (+14%) were observed for the omnivore participants compared to vegetarian participants. Positive correlations (p < 0.001) were noted between creatinine and LBM (R2 = 0.42), creatinine and handgrip strength (R2 = 0.41), protein intake and LBM (R2 = 0.29), and handgrip strength and LBM (R2 = 0.69). These data show that serum creatinine concentrations were lower in vegetarian women and men in comparison to their omnivorous counterparts and that serum creatinine concentrations correlate with LBM and strength in healthy adults, regardless of diet.
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