Plant-Fed Kidneys

By Alicia Jerome MS, RD, LD

Advocating for a Low-Protein, Plant-Based Diet in CKD Management

Chronic Kidney Disease (CKD) is a serious health condition that affects millions of people worldwide. While various treatment strategies exist, one of the most effective yet underutilized approaches is a low-protein diet centered on plant-based proteins. Research consistently demonstrates that reducing protein intake can slow CKD progression, and substituting animal protein with plant-based sources provides additional benefits, including reduced cardiovascular risk and improved overall health outcomes.1

The Case for Lower Protein Intake in CKD

Before the widespread availability of dialysis, low-protein diets were the gold standard for CKD treatment.1  A reanalysis of the MDRD (Modification of Diet in Renal Disease) trial revealed that decreasing protein intake from 0.9 g/kg to 0.6 g/kg body weight per day resulted in a 33% slowdown in kidney damage progression.1 This highlights the critical role that dietary protein plays in managing CKD. 

Why Choose Plant-Based Proteins?

Shifting from animal-based to plant-based proteins offers several advantages for CKD patients:

1. Reduced Toxic Metabolites – Animal proteins contribute to the production of trimethylamine N-oxide (TMAO), a gut-derived compound linked to both kidney toxicity and cardiovascular disease. By choosing plant proteins, CKD patients can lower TMAO levels and reduce cardiovascular risks. 1
2. Lower Phosphorus Load – Inorganic phosphorus from food additives in processed meats and dairy is absorbed at a 90% rate, whereas organic phosphorus from plant-based foods is absorbed at a much lower rate. This difference helps reduce phosphorus-related complications in CKD. 1
3. Less Acid Load on Kidneys – Animal proteins create an acidic metabolic environment that can accelerate kidney function decline, whereas plant proteins generate a more favorable acid-base balance, reducing kidney strain. 1
4. Better Cardiovascular Outcomes – Cardiovascular disease is the leading cause of death among CKD patients. A study from the University of Utah School of Medicine found that for every 33% increase in plant protein relative to total protein intake, there was a 23% reduction in mortality risk. 2

Plant-Based Diets and Hypertension Control

Hypertension is a major contributor to CKD progression. The DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes plant-based foods, has been shown to improve blood pressure control. It recommends consuming 7 to 12 servings of fruits and vegetables daily while reducing sodium intake to 2,300 mg per day, with an eventual goal of 1,500 mg per day. These changes can help manage CKD-related hypertension and reduce cardiovascular risks.

In a study by Lindahl and colleagues, 26 patients with long-term hypertension adopted a vegan diet for one year.3 As a result, 20 of the patients were able to discontinue antihypertensive medications entirely. This underscores the potential of a plant-based diet to significantly improve CKD-related hypertension.

Addressing Nutritional Deficiencies in a Low-Protein Diet

One common concern with plant-based low-protein diets is ensuring adequate essential nutrient intake. Here are some strategies to address this:

• Protein Quality: Although plant proteins have a lower biological value than animal proteins, combining different sources (e.g., grains and legumes) each day ensures a complete amino acid profile.1
• Amino Acid Supplementation: Some amino acid supplements can be lacking in tryptophan, which should be accounted for in dietary planning.1
• Micronutrient Balance: Patients should monitor phosphorus, sodium, and potassium intake to prevent imbalances that could worsen CKD symptoms.1

What is the Hurdle for Making These Recommendations?

Despite strong evidence that a lower-protein, plant-based diet is ideal for managing chronic kidney disease, why is it not the gold standard of care?

Jennifer Moore, author of “Plant-Fed Kidneys”, suggests fears around a lower-protein, plant-based diet include fear of malnutrition, assumed low adherence to the diet, longer nutrition counseling appointments with regular follow-ups, and lack of training for the healthcare professionals.1

How RDNs Can Help Their Patients Implement a Plant-Based Low-Protein Diet

Moore, suggests these steps for helping a CKD patient adopt a plant-based, low-protein diet.1

1. Discover the patient’s “why”. A patient’s why will drive their compliance. 
2. Educate the patient on the physiology of kidney disease. Help the patient “Get it!”
3. Eliminate animal protein. Help the patient see how removing animal protein will help the kidneys rest. 
4. Provide the “how to”. Teach the patient about food, meal planning, grocery shopping, etc.
5. Supplement with vitamins B12 and D.
6. Severely limit sodium.
7. Lower protein intake further if at CKD stage 4.
8. Supplement with amino acids.
9. Monitor and manage electrolytes.
10. Have patient speak with MD about acidosis, anemia, and bone disease. 
    

Conclusion

Adopting a plant-based low-protein diet offers significant benefits for CKD patients, including slowed disease progression, improved cardiovascular health, and better overall well-being. Despite the overwhelming evidence supporting this dietary approach, it remains underutilized in CKD care. By increasing awareness and providing proper dietary education, healthcare providers can help patients take proactive steps toward managing their kidney health through nutrition.

For more information, see Helm Publishing's course on Plant-Fed Kidneys!

References: 

1.    Moore Jennifer Moore, MS, RDN, CSR, LDN, J. (2019). Plant-Fed Kidneys: The Diet to Slow Progression of Chronic Kidney Disease. Vegwell Nutrition.

2.    Plant Protein Reduces Mortality in Chronic Kidney Disease Patients. The National Kidney Foundation. 2017. Available at: http://www.kidney.org/news/plant-protein-reduces-mortality-chronic-kidney-disease-patients.

3.    Yokoyama Y, Nishimura K, Barnard N et al. Vegetarian Diets and Blood Pressure. JAMA Internal Medicine. 2014: 174(4):577. Doi:10.1001/jamainternmed.2013.14547.