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Dietary management of chronic kidney disease: protein restriction and beyond.
Curr Opin Nephrol Hypertens. 2012 Nov; 21(6):635-40.CO

Abstract

PURPOSE OF REVIEW

More kidney protective strategies are needed to reduce the burden of complete kidney failure from chronic kidney disease (CKD). Clinicians sometimes use protein restriction as kidney protection despite its demonstrated lack of effectiveness in the only large-scale study. Small-scale studies support that dietary acid reduction is kidney-protective, including when done with base-inducing foods like fruits and vegetables. We review these studies in light of current kidney-protective recommendations.

RECENT FINDINGS

Animal models of CKD show that acid-inducing dietary protein exacerbates and base-inducing protein ameliorates nephropathy progression, and that increased intake of acid-inducing but not base-inducing dietary protein exacerbates progression. Clinical studies show that dietary acid reduction with Na-based alkali reduces kidney injury and slows nephropathy progression in patients with CKD and reduced glomerular filtration rate (GFR); base-inducing fruits and vegetables reduce kidney injury in patients with reduced GFR; and base-inducing fruits and vegetables improve metabolic acidosis in CKD.

SUMMARY

Protein type rather than amount might more importantly affect nephropathy progression. Base-inducing foods might be another way to reduce dietary acid, a strategy shown in small studies to slow nephropathy progression. Further studies will determine if CKD patients should be given base-inducing food as part of their management.

Authors+Show Affiliations

Texas A&M Health Sciences Center College of Medicine, Temple, Texas 76508, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23079747

Citation

Goraya, Nimrit, and Donald E. Wesson. "Dietary Management of Chronic Kidney Disease: Protein Restriction and Beyond." Current Opinion in Nephrology and Hypertension, vol. 21, no. 6, 2012, pp. 635-40.
Goraya N, Wesson DE. Dietary management of chronic kidney disease: protein restriction and beyond. Curr Opin Nephrol Hypertens. 2012;21(6):635-40.
Goraya, N., & Wesson, D. E. (2012). Dietary management of chronic kidney disease: protein restriction and beyond. Current Opinion in Nephrology and Hypertension, 21(6), 635-40. https://doi.org/10.1097/MNH.0b013e328357a69b
Goraya N, Wesson DE. Dietary Management of Chronic Kidney Disease: Protein Restriction and Beyond. Curr Opin Nephrol Hypertens. 2012;21(6):635-40. PubMed PMID: 23079747.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary management of chronic kidney disease: protein restriction and beyond. AU - Goraya,Nimrit, AU - Wesson,Donald E, PY - 2012/10/20/entrez PY - 2012/10/20/pubmed PY - 2013/3/30/medline SP - 635 EP - 40 JF - Current opinion in nephrology and hypertension JO - Curr Opin Nephrol Hypertens VL - 21 IS - 6 N2 - PURPOSE OF REVIEW: More kidney protective strategies are needed to reduce the burden of complete kidney failure from chronic kidney disease (CKD). Clinicians sometimes use protein restriction as kidney protection despite its demonstrated lack of effectiveness in the only large-scale study. Small-scale studies support that dietary acid reduction is kidney-protective, including when done with base-inducing foods like fruits and vegetables. We review these studies in light of current kidney-protective recommendations. RECENT FINDINGS: Animal models of CKD show that acid-inducing dietary protein exacerbates and base-inducing protein ameliorates nephropathy progression, and that increased intake of acid-inducing but not base-inducing dietary protein exacerbates progression. Clinical studies show that dietary acid reduction with Na-based alkali reduces kidney injury and slows nephropathy progression in patients with CKD and reduced glomerular filtration rate (GFR); base-inducing fruits and vegetables reduce kidney injury in patients with reduced GFR; and base-inducing fruits and vegetables improve metabolic acidosis in CKD. SUMMARY: Protein type rather than amount might more importantly affect nephropathy progression. Base-inducing foods might be another way to reduce dietary acid, a strategy shown in small studies to slow nephropathy progression. Further studies will determine if CKD patients should be given base-inducing food as part of their management. SN - 1473-6543 UR - https://www.unboundmedicine.com/medline/citation/23079747/Dietary_management_of_chronic_kidney_disease:_protein_restriction_and_beyond_ L2 - https://doi.org/10.1097/MNH.0b013e328357a69b DB - PRIME DP - Unbound Medicine ER -