A healthy, plant-based diet rich in fruits, vegetables, legumes, cereals, whole grains, and fiber and low in red meat, salt, and refined sugars may reduce the risk of early death in people with chronic kidney disease (CKD).

“This finding represents a shift in evidence from management of single nutrient or food groups in the care of kidney disease, and aligns with the experiences of patients who describe nutritional advice as frequently complex and difficult to follow, ”a team led by Giovanni Strippoli, MD, PhD, of the University of Bari in Italy and Diaverum in Sweden, and Jaimon T. Kelly of Bond University in Queensland, Australia, stated in the Clinical Journal of American Society of Nephrology.

Traditionally, CKD patients have been taught to restrict individual nutrients, such as phosphorus, salt, potassium, and protein, but limited evidence show that these efforts prevent complications, according to the investigators.

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“Interventions to support adherence to increased fruit and vegetable, fish, legume, whole grain, and fiber intake, and reduced red meat, sodium, and refined sugar intake could be effective tools to lower mortality in people with kidney disease,” the researchers noted.

Dr Strippoli, Dr Kelly, and colleagues performed a systematic review and meta-analysis of 7 recently published studies 2013 to 2015 of 15,285 patients from the United States, Sweden, and Japan. The survival benefit emerged from an analysis of 6 of the studies involving 13,930 CKD patients with an estimated glomerular filtration rate (eGFR) below 60 to 70 mL/min/1.73m2 or albuminuria, of whom 3983 died during follow up. Based on an estimated 5-year mortality of 17%, the investigators calculated that a healthy diet as described would prevent 46 deaths per 1000 people over that period. Individuals who followed the healthy eating pattern had a 27% lower risk of death from any cause.

Unlike some previous research, the investigators found no significant associations between consumption of healthy, whole foods and progression to end-stage renal disease. Neither patient age nor country of origin accounted for the outcomes.

Since the meta-analysis was based on observational studies, the investigators recommended a future randomized trial to further examine dietary influences, such as red meat, in CKD patients. In this review, a healthy diet was plant-based but not otherwise consistently defined, with some including milk and others not. Patients also had various levels of kidney function.

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1. Kelly JT, Palmer SC, Ning Wai S,Ruospo M, Carrero JJ, Campbell KL, and Strippoli GFM. Healthy Dietary Patterns and Risk of Mortality and ESRD in CKD: A Meta-Analysis of Cohort Studies. Clin J Am Soc Nephrol. doi: 10.2215/CJN.06190616. [Epub ahead of print]

2. Healthy Diet May Help Kidney Disease Patients Live Longer [press release]. American Society of Nephrology; December 8, 2016.