Adhering to a healthy diet may reduce the risk of chronic kidney disease (CKD) and albuminuria, according to a new systematic review and meta-analysis.

Such a diet is rich in vegetables, fruit, legumes, nuts, whole grains, fish, and low-fat dairy products and low in red and processed meats, sodium, and sugar-sweetened beverages.

Jaimon T. Kelly, PhD, of Bond University in Australia, and collaborators, analyzed 18 studies that included a total of 630,108 healthy adults followed for a mean 10.4 years. Their meta-analysis of low to moderate grade studies found that a healthy dietary pattern was associated with a 30% lower incidence of CKD and a 23% lower incidence of albuminuria, according to results published in the Clinical Journal of the American Society of Nephrology.

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The dietary patterns that were most frequently studied included the Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension) diet, and US dietary guidelines. The diets do differ in some respects, however. For example, the Mediterranean diet includes moderate alcohol consumption and excludes sugar-sweetened beverages, whereas DASH excludes alcohol and includes sugar-sweetened beverages.

Although these diets emphasize whole foods containing fiber and nutrients such as vitamin C, vitamin E, and carotenoids, it is the synergy of food groups that may be most important for health, according to the investigators.

“These results add to the accumulating evidence base supporting the benefits of adherence to healthy dietary patterns for chronic conditions, including those which are considered to be risk factors for the development of kidney disease such as type 2 diabetes, hypertension, cardiovascular [disease], and increased weight,” Dr Kelly’s team wrote.

In an accompanying editorial, Emily A. Hu, a PhD candidate, and Casey M. Rebholz, PhD, MS, both of Johns Hopkins University in Baltimore, noted, “The timing of a healthy dietary intervention may be critical, as diet modification may be more effective in preventing CKD in a healthy population than preventing ESKD among individuals already diagnosed with CKD.”

The study did not adequately explore racial differences, which is a limitation, according to the editorialists. More research, including randomized trials, is needed to test specific dietary patterns and the role of beverages, they wrote.

“Meanwhile, there may be sufficient observational evidence for clinicians to emphasize the importance of healthy dietary patterns to individuals who are healthy or who are at risk of developing CKD.”

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Bach KE, Kelly JT, Palmer SC, et al. Healthy dietary patterns and incidence of CKD: A meta-analysis of cohort studies. Clin J Am Soc Nephrol. doi:10.2215/CJN.00530119
Hu EA, Rebholz CM. Can dietary patterns modify risk for CKD? Clin J Am Soc Nephrol. doi:10.2215/CJN.09440819