Dietary Intervention in Phosphatemia Control–Nutritional Traffic Light Labeling

Watanabe, Marcela Tatiana; Barretti, Pasqual; Júnior, João Garcia Caramori

doi:10.1053/j.jrn.2018.04.005

Cited by 8 publications

(6 citation statements)

References 10 publications

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“… Reduced phosphorus burden: there is less absorbable phosphorus in plant-based proteins given the presence of indigestible phytate binding to plant-based phosphorus. Fruits and vegetables are less likely to have added phosphorus-based preservatives that are often used for meat processing [ 59 , 73 , 74 , 75 ]. Modulation of advanced glycation end products (AGE’s): higher dietary fiber intake results in a favorable modulation of AGE [ 76 ], which can slow CKD progression [ 77 ], enhance GI motility, and lower the likelihood of constipation that is a likely contributor to hyperkalemia.…”

Section: Benefits Of a Plant-dominant Low Protein Dietmentioning

confidence: 99%

Section: Benefits Of a Plant-dominant Low Protein Dietmentioning

confidence: 99%

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Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

et al. 2020

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Chronic kidney disease (CKD) affects >10% of the adult population. Each year, approximately 120,000 Americans develop end-stage kidney disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates, exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6–0.8 g/kg/day composed of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, is promising and consistent with the precision nutrition. The scientific premise of the PLADO stems from the observations that high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of constipation with resulting hyperkalemia from the typical low fiber intake. A plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

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Section: Benefits Of a Plant-dominant Low Protein Dietmentioning

confidence: 99%

Section: Benefits Of a Plant-dominant Low Protein Dietmentioning

confidence: 99%

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

et al. 2020

View full text Add to dashboard Cite

show abstract

“…11 (3) There is less absorbable phosphorus in plant-based protein given the preponderance of indigestible phytate as the main source of phosphorus and given that fresh fruits or vegetables are less likely to have added phosphorus-based preservatives that are often used for meat processing. 12,13 (4) Higher dietary fiber intake, in addition to a favorable modulation of advanced glycation end products, 14 enhances gastrointestinal motility and lowers the likelihood of constipation, which is a likely contributor to hyperkalemia. (5) A vegan diet based on fresh fruits and vegetables lessen the likelihood of exposure to potassium-based additives.…”

mentioning

confidence: 99%

Does Kidney Longevity Mean Healthy Vegan Food and Less Meat or Is Any Low-Protein Diet Good Enough?

Kalantar-Zadeh

Moore

2019

Journal of Renal Nutrition

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“…Hence, PLAFOND is a type of 'plant dominant LPD' also known as PLADO diet [25 && ] with lower glycemic index compared to other PLADO diet categories. There are multiple pathways by which LPD with >50% plants ameliorates CKD progression, in addition to reducing glomerular hyperfiltration and intra-glomerular pressure, as also shown in Table 1: [51] (1) reduction in nitrogenous compounds; [48] (2) synergism with RAAS and SGLT2 inhibitors; [52] (3) attenuation of metabolites linked with CKD and CV disease including via trimethylamine (TMA) and TMA N-oxide (TMAO) implicated in atherosclerosis, renal fibrosis axis [69], and CV disease and mortality; [70] (4) decreased acid load from plant-dominant diets; [71] (5) reduced phosphorus burden given less bioavailable phosphorus in plant-based protein and less added phosphorus-based preservatives that are typically used for meat processing; [60,[72][73][74] (6) favorable modulation of advanced glycation end products by higher dietary fiber [75,76] and enhancing GI motility with lower likelihood of constipation, a likely contributor to hyperkalemia; [77,78 && ] (7) favorable effects on potassium metabolism given lower likelihood of potassium-based additives that are often in meat products; [79,80] (8) anti-inflammatory and antioxidant effects from higher intake of natural anti-inflammatory and antioxidant ingredients including carotenoids, tocopherols, and ascorbic acid; [81,82] (9) favorable impact on the gut microbiome [83] leading to lower uremic toxin generation. As stated in our study protocol, in CKD patients who develop signs of PEW or acute kidney injury (AKI), higher DPI targets will be temporarily used until PEW or AKI is resolved.…”

Section: Additional Benefits Of a Plant-focused Meal Plansmentioning

confidence: 99%

Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes

Kalantar-Zadeh

Rhee

Joshi

et al. 2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewNearly half of all Americans with chronic kidney disease (CKD) also have type-2-diabetes (T2D). Whereas traditional and emerging pharmacotherapies are increasingly frequently used for the management of CKD in diabetes (CKD/DM), the role of integrated or multimodal interventions including the potentially synergistic and additive effect of diet and lifestyle modifications in addition to pharmacotherapy has not been well examined, in sharp contrast to the well-known integrated approaches to heart disease. Recent findingsLow-carbohydrate low-fat diets are often recommended in T2D, whereas low-protein diets (LPD) are recommended by guidelines for nondiabetic CKD with increasing emphasis on plant-based protein sources. High-protein diets with greater animal protein lead to glomerular hyperfiltration, especially in patients with T2D, and faster decline in renal function. Guidelines provide differing recommendations regarding the amount (low vs high) and source (plant vs animal) of dietary protein intake (DPI) in CKD/DM. Some such as KDIGO recommend 0.8 g/kg/day based on insufficient evidence for DPI restriction in CKD/DM, whereas KDOQI and ISRNM recommend a DPI of 0.6 to <0.8 g/kg/day. A patient-centered plant-focused LPD for the nutritional management of CKD/DM (PLAFOND), a type of PLADO diet comprising DPI of 0.6 to <0.8 g/kg/day with >50% plant-based sources, high dietary fiber, low glycemic index, and 25-35 Cal/kg/day energy, can be implemented by renal dietitians under Medical Nutrition Therapy.

show abstract

Dietary Intervention in Phosphatemia Control–Nutritional Traffic Light Labeling

Cited by 8 publications

References 10 publications

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

Does Kidney Longevity Mean Healthy Vegan Food and Less Meat or Is Any Low-Protein Diet Good Enough?

Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes

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