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Moldovan D, Rusu CC, Potra AR, Tirinescu D, Ticala M, Maslyennikov Y, Bărar AA, Urs A, Kacso IM. Nutritional Intervention and Musculoskeletal Health in Chronic Kidney Disease. Nutrients 2025; 17:896. [PMID: 40077766 PMCID: PMC11901936 DOI: 10.3390/nu17050896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 02/21/2025] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open
Abstract
Chronic kidney disease (CKD) is a leading condition in terms of prevalence and overall health impact. With the increased life expectancy of the CKD population and the improvement in medical care, controlling musculoskeletal complications remains a tough challenge. Patients with CKD are prone to falls, fractures and sarcopenia, enhancing the risk of death. A multitude of mechanisms contribute to fractures, and treatment is suboptimal; therefore, prevention must stand out as a key step. This review aims to provide an overview of the most relevant data regarding the impact of nutrition on bone disorders and sarcopenia in CKD. The newest relevant studies emphasize that plant protein intake is associated with a lower production of uremic toxins, lower serum phosphorus levels, and stronger bones. We conclude that patients with CKD should adopt specific diets tailored to the presence of osteoporosis, renal osteodystrophy, and muscle wasting. Low-protein diets or plant-dominant diets containing an adequate amount of protein could be better choices for predialysis patients with CKD in order to protect their bones and muscles, whereas in the dialysis population, a higher protein intake could be essential to prevent osteoporosis and sarcopenia. In all patients with CKD, focusing on antioxidant food intake could provide a strong antiaging benefit through ensuring good musculoskeletal health.
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Affiliation(s)
- Diana Moldovan
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Crina Claudia Rusu
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Alina Ramona Potra
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Dacian Tirinescu
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Maria Ticala
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Yuriy Maslyennikov
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
| | - Andrada Alina Bărar
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
| | - Alexandra Urs
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
| | - Ina Maria Kacso
- Department of Nephrology, ‘‘Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania (A.R.P.); (D.T.); (M.T.); (Y.M.); (A.A.B.)
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400012 Cluj-Napoca, Romania
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Kaimori JY, Sakaguchi Y, Oka T, Isaka Y. Plant-Dominant Low-Protein Diets: A Promising Dietary Strategy for Mitigating Disease Progression in People with Chronic Kidney Disease-A Comprehensive Review. Nutrients 2025; 17:643. [PMID: 40004970 PMCID: PMC11857991 DOI: 10.3390/nu17040643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 02/04/2025] [Accepted: 02/10/2025] [Indexed: 02/27/2025] Open
Abstract
Chronic kidney disease (CKD) is a global health crisis affecting over 10% of the population, with mortality rates increasing significantly. Current management strategies, including expensive medications and renal replacement therapies, highlight the need for cost-effective, conservative approaches. This review examines the evidence for plant-dominant low-protein diets (PLADO) in managing non-dialysis-dependent CKD. Existing guidelines for protein restriction in CKD vary considerably, with inconsistencies and a lack of personalization noted in the KDOQI and KDIGO recommendations. While traditional low-protein diet trials show limited success due to poor adherence and marginal benefits, PLADO offers a potentially more sustainable alternative. PLADO's advantages include improved nutrient density, reduced dietary acid load, anti-inflammatory effects, and beneficial modulation of the gut microbiome, potentially reducing uremic toxins and improving cardiovascular health. However, challenges remain, including adherence issues, potential nutrient deficiencies, and potassium management. Although observational studies show promise, further large-scale randomized controlled trials are necessary to validate PLADO's efficacy and establish optimal dietary composition. A personalized, multidisciplinary approach is essential for successful implementation and monitoring to maximize PLADO's benefits in improving outcomes for individuals with NDD-CKD.
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Affiliation(s)
- Jun-Ya Kaimori
- Department of Health and Nutrition, Otemae University, 2-1-88 Otemae, Chuo-ku, Osaka 540-0008, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; (Y.S.); (T.O.); (Y.I.)
| | - Yusuke Sakaguchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; (Y.S.); (T.O.); (Y.I.)
| | - Tatsufumi Oka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; (Y.S.); (T.O.); (Y.I.)
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; (Y.S.); (T.O.); (Y.I.)
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Elshoff D, Mehta P, Ziouzenkova O. Chronic Kidney Disease Diets for Kidney Failure Prevention: Insights from the IL-11 Paradigm. Nutrients 2024; 16:1342. [PMID: 38732588 PMCID: PMC11085624 DOI: 10.3390/nu16091342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Nearly every fifth adult in the United States and many older adults worldwide are affected by chronic kidney disease (CKD), which can progress to kidney failure requiring invasive kidney replacement therapy. In this review, we briefly examine the pathophysiology of CKD and discuss emerging mechanisms involving the physiological resolution of kidney injury by transforming growth factor beta 1 (TGFβ1) and interleukin-11 (IL-11), as well as the pathological consequences of IL-11 overproduction, which misguides repair processes, ultimately culminating in CKD. Taking these mechanisms into account, we offer an overview of the efficacy of plant-dominant dietary patterns in preventing and managing CKD, while also addressing their limitations in terms of restoring kidney function or preventing kidney failure. In conclusion, this paper outlines novel regeneration strategies aimed at developing a reno-regenerative diet to inhibit IL-11 and promote repair mechanisms in kidneys affected by CKD.
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Affiliation(s)
- Denise Elshoff
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA;
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA;
| | - Priyanka Mehta
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA;
| | - Ouliana Ziouzenkova
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA;
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Sahin K, Yıldıran H. A Therapeutic Approach in the Management of Chronic Kidney Disease: Plant-Based Dietary Models and Associated Parameters. Curr Nutr Rep 2024; 13:39-48. [PMID: 38172460 DOI: 10.1007/s13668-023-00515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Chronic kidney disease is one of the leading causes of death worldwide today. Nutrition and nutrition-related factors have a very important role in both the prevention and management of the disease. Plant-based dietary practices are one of the promising approaches to chronic kidney disease. This review aims to examine the potential benefits and risks of plant-based diet models on symptoms and indices used in diet quality in chronic kidney disease. RECENT FINDINGS Recently, a growing body of evidence has shown that, unlike animal-based diets, diets rich in plant-based nutrients may play an active role in the incidence of chronic kidney disease in many ways and the management of common symptoms, such as metabolic acidosis, uremic toxicity, and hyperphosphatemia. Implementation of existing plant-based dietary patterns in patients with chronic kidney disease may increase the efficacy of the diet and improve patients' quality of life by expanding their food choices. While there are concerns about creatine deficiency, dietary adequacy, and accessibility regarding plant-based diets, available information is limited.
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Affiliation(s)
- Kezban Sahin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balıkesir, 10200, Turkey.
| | - Hilal Yıldıran
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Moldovan D, Rusu C, Potra A, Tirinescu D, Ticala M, Kacso I. Food to Prevent Vascular Calcification in Chronic Kidney Disease. Nutrients 2024; 16:617. [PMID: 38474744 DOI: 10.3390/nu16050617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Vascular calcification (VC) is a consequence of chronic kidney disease (CKD) which is of paramount importance regarding the survival of CKD patients. VC is far from being controlled with actual medication; as a result, in recent years, diet modulation has become more compelling. The concept of medical nutritional therapy points out the idea that food may prevent or treat diseases. The aim of this review was to evaluate the influence of food habits and nutritional intervention in the occurrence and progression of VC in CKD. Evidence reports the harmfulness of ultra-processed food, food additives, and animal-based proteins due to the increased intake of high absorbable phosphorus, the scarcity of fibers, and the increased production of uremic toxins. Available data are more supportive of a plant-dominant diet, especially for the impact on gut microbiota composition, which varies significantly depending on VC presence. Magnesium has been shown to prevent VC but only in experimental and small clinical studies. Vitamin K has drawn considerable attention due to its activation of VC inhibitors. There are positive studies; unfortunately, recent trials failed to prove its efficacy in preventing VC. Future research is needed and should aim to transform food into a medical intervention to eliminate VC danger in CKD.
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Affiliation(s)
- Diana Moldovan
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Crina Rusu
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Alina Potra
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Dacian Tirinescu
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Maria Ticala
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Ina Kacso
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
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Altamura S, Pietropaoli D, Lombardi F, Del Pinto R, Ferri C. An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease. Biomedicines 2023; 11:3033. [PMID: 38002033 PMCID: PMC10669155 DOI: 10.3390/biomedicines11113033] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic kidney disease (CKD) is a severe condition and a significant public health issue worldwide, carrying the burden of an increased risk of cardiovascular events and mortality. The traditional factors that promote the onset and progression of CKD are cardiometabolic risk factors like hypertension and diabetes, but non-traditional contributors are escalating. Moreover, gut dysbiosis, inflammation, and an impaired immune response are emerging as crucial mechanisms in the disease pathology. The gut microbiome and kidney disease exert a reciprocal influence commonly referred to as "the gut-kidney axis" through the induction of metabolic, immunological, and endocrine alterations. Periodontal diseases are strictly involved in the gut-kidney axis for their impact on the gut microbiota composition and for the metabolic and immunological alterations occurring in and reciprocally affecting both conditions. This review aims to provide an overview of the dynamic biological interconnections between oral health status, gut, and renal pathophysiology, spotlighting the dynamic oral-gut-kidney axis and raising whether periodontal diseases and gut microbiota can be disease modifiers in CKD. By doing so, we try to offer new insights into therapeutic strategies that may enhance the clinical trajectory of CKD patients, ultimately advancing our quest for improved patient outcomes and well-being.
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Affiliation(s)
- Serena Altamura
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- PhD School in Medicine and Public Health, Center of Oral Diseases, Prevention and Translational Research—Dental Clinic, 67100 L’Aquila, Italy
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
| | - Davide Pietropaoli
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Center of Oral Diseases, Prevention and Translational Research—Dental Clinic, 67100 L’Aquila, Italy
| | - Francesca Lombardi
- Laboratory of Immunology and Immunopathology, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Rita Del Pinto
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100 L’Aquila, Italy
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Rhee CM, Wang AYM, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, Ko GJ, Piccoli GB, Garibotto G, Brunori G, Sumida K, Lambert K, Moore LW, Han SH, Narasaki Y, Kalantar-Zadeh K. Nutritional and Dietary Management of Chronic Kidney Disease Under Conservative and Preservative Kidney Care Without Dialysis. J Ren Nutr 2023; 33:S56-S66. [PMID: 37394104 PMCID: PMC10756934 DOI: 10.1053/j.jrn.2023.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis.
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Affiliation(s)
- Connie M Rhee
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California.
| | - Angela Yee-Moon Wang
- University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Diana Zarantonello
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | | | | | - Giuliano Brunori
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Keiichi Sumida
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoko Narasaki
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
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Mediterranean Dietary Pattern Adjusted for CKD Patients: The MedRen Diet. Nutrients 2023; 15:nu15051256. [PMID: 36904256 PMCID: PMC10005115 DOI: 10.3390/nu15051256] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/04/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
A number of studies in the general population showed that healthy dietary patterns, such as the Mediterranean Diet, can improve or prevent the development of several chronic diseases and are associated with a significant reduction in all-cause and cardiovascular mortality. The Mediterranean diet may also have favorable effects for the prevention of chronic kidney disease (CKD), but no evidence of renoprotection exists in CKD patients. The Mediterranean Renal (MedRen) diet is an adaptation of the Mediterranean diet recommendations comprising a quantitative reduction in the RDA values of protein, salt and phosphate intake for the general population. Hence, MedRen supplies 0.8 g/Kg of protein, 6 g of salt and less than 800 mg of phosphate daily. Obviously, there is a preference for products of plant origin, which contain more alkali, fibers, unsaturated fatty acids than animal-based food. The MedRen diet can be implemented easily in mild-to-moderate stages of CKD with good results, both in terms of adherence to prescriptions and metabolic compensation. In our opinion, it should be the first step of CKD stage 3 nutritional management. This paper describes the features and reports our experience in the implementation of the MedRen diet as an early nutritional approach to CKD.
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