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Following a plant-based diet may reduce risk for CKD, slow eGFR decline
Adherence to a healthy plant-based diet — one that is high in fruits, vegetables, whole grains, nuts and legumes — was associated with a lower risk for incident chronic kidney disease and helped to slow eGFR decline compared to diets high in refined carbohydrates and animal foods, according to a recently published study.
“This is the first study to report prospective associations between plant-based diets and risk of kidney function decline and CKD in the general population,” Hyunju Kim, postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health in the department of epidemiology, told Healio/Nephrology. “We used all available scoring systems to characterize study participants’ diets. These scoring systems allowed us to assess if a person’s diet was high in healthful plant foods, less healthful plant foods and animal foods, and enabled us to establish the robustness of our findings with respect to different types of plant-based diets and CKD risk. Higher consumption of healthful plant foods played an important role in CKD risk and slower decline in kidney function.”
To examine the relationship between different plant-based diets and both CKD risk and kidney function decline, researchers analyzed data from 14,686 adults enrolled in the Atherosclerosis Risk in Communities study. Food questionnaires were administered to participants to assess their usual intake of foods and beverages. Researchers constructed an overall plant-based diet index (healthy and less healthy plant foods positively scored), a healthy plant-based diet index (healthy plant foods positively scored), a less healthy plant-based diet index (less healthy plant foods positively scored) and a pro-vegetarian diet index (selected plant foods positively scored). In all diet plans, animal foods were negatively scored. The diet scores were divided into quintiles, and patients were followed for a median of 24 years. During this time, 4,343 cases of incident CKD occurred.
Researchers found greater adherence to a healthy plant-based diet and a pro-vegetarian diet were both associated with a lower risk for CKD and that participants who had the greatest adherence to a healthy plant-based diet had a 14% lower risk for developing CKD than those with the lowest adherence (healthy plant-based HR quintile 5 vs. quintile 1 = 0.86; pro-vegetarian HR quintile 5 vs. quintile 1 = 0.90).
In contrast, higher adherence to a less healthy plant-based diet was associated with an elevated risk for CKD (HR quintile 5 vs. quintile 1 = 1.11).
It was also observed that greater adherence to an overall plant-based diet and a healthy plant-based diet were associated with slower eGFR decline.
Finally, researchers found the proportion of CKD attributable to lower adherence to plant-based diets was 4.1%.
“A small but statistically significant percentage of CKD cases could have been avoided with higher adherence to plant-based diets,” Kim said. “This result suggests that dietary modification may be considered for primary prevention of CKD. Currently, no clear thresholds exist on absolute levels of plant or animal food intake that is associated with health outcomes. Future studies should consider using a different dietary measurement tool (eg, 24-hour dietary recalls) to assess the association between absolute levels of plant or animal food intake and kidney outcomes.”
In a related editorial entitled “Diet and Risk of Kidney Disease,” Patrick Gee, who formerly spent 4.5 years on peritoneal dialysis, wrote: “One of the vital areas with most research studies on nutrition is that the researchers, PI, scientists, clinicians and medical teams fail to truly understand the socioeconomical challenges that the most effected populations have to endure. Everyone wants to eat a healthy, nutritional meal [and] yet, either affordability, locality, convenience or access is a hinderance to achieving this goal.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.