Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Diet as a treatment for chronic kidney disease

  • Jiwon Jung (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Joo Hoon Lee (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine)
  • Received : 2024.09.25
  • Accepted : 2024.10.22
  • Published : 2024.10.31
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Abstract

The management of chronic kidney disease (CKD) includes nutritional interventions aimed at slowing disease progression and mitigating complications. This review examines various dietary approaches for CKD treatment, focusing on carbohydrate intake modulation, ketogenic diets, and plant-based diets. Standard guidelines recommend carbohydrate intake within 45% to 65% of total calories, but there is growing interest in reducing carbohydrate consumption to preserve kidney function. Low-carbohydrate diets (<25% of total calories) have shown benefits in glycemic control and weight reduction but may pose long-term adherence challenges. High-protein, low-carbohydrate diets are discouraged due to associations with hyperfiltration and CKD progression. Limiting fructose intake has been linked to reductions in blood pressure and uric acid levels. Intermittent fasting and ketogenic diets, which promote ketone body production and reduce inflammation, have shown promise in animal models and some human studies, particularly in autosomal dominant polycystic kidney disease, though more research is needed. Plant-based diets, such as the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, offer cardiovascular benefits and may reduce CKD risk but require careful management of potassium intake. Overall, dietary interventions should be individualized, considering potential risks like hyperkalemia and ensuring nutritional adequacy.

Keywords

References

  1. KDOQI Work Group. KDOQI clinical practice guideline for nutrition in children with CKD: 2008update: executive summary. AmJ Kidney Dis 2009;53(3 Suppl 2):S11-104. 
  2. Joshi S, Kalantar-Zadeh K, Chauveau P, Carrero JJ. Risks and benefits of different dietary patterns in CKD. Am J Kidney Dis 2023;81:352-60. 
  3. Naude CE, Brand A, Schoonees A, Nguyen KA, Chaplin M, Volmink J. Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk. Cochrane Database Syst Rev 2022;1:CD013334. 
  4. Oyabu C, Hashimoto Y, Fukuda T, Tanaka M, Asano M, Yamazaki M, et al. Impact of low-carbohydrate diet on renal function: a meta-analysis of over 1000 individuals from nine randomised controlled trials. Br J Nutr 2016;116:632-8. 
  5. Farhadnejad H, Asghari G, Emamat H, Mirmiran P, Azizi F. Low-carbohydrate high-protein diet is associated with increased risk of incident chronic kidney diseases among Tehranian adults. J Ren Nutr 2019;29:343-9. 
  6. Brymora A, Flisinski M, Johnson RJ, Goszka G, Stefanska A, Manitius J. Low-fructose diet lowers blood pressure and inflammation in patients with chronic kidney disease. Nephrol Dial Transplant 2012;27:608-12. 
  7. Gershuni VM, Yan SL, Medici V. Nutritional ketosis for weight management and reversal of metabolic syndrome. Curr Nutr Rep 2018;7:97-106. 
  8. Kundu S, Hossain KS, Moni A, Zahan MS, Rahman MM, Uddin MJ. Potentials of ketogenic diet against chronic kidney diseases: pharmacological insights and therapeutic prospects. Mol Biol Rep 2022;49:9749-58. 
  9. Rowe I, Chiaravalli M, Mannella V, Ulisse V, Quilici G, Pema M, et al. Defective glucose metabolism in polycystic kidney disease identifies a new therapeutic strategy. Nat Med2013;19:488-93. 
  10. Kipp KR, Rezaei M, Lin L, Dewey EC, Weimbs T. A mild reduction of food intake slows disease progression in an orthologous mouse model of polycystic kidney disease. Am J Physiol Renal Physiol 2016;310:F726-31. 
  11. Warner G, Hein KZ, Nin V, Edwards M, Chini CC, Hopp K, et al. food restriction ameliorates the development of polycystic kidney disease. J Am Soc Nephrol 2016;27:1437-47. 
  12. Oehm S, Steinke K, Schmidt J, Arjune S, Todorova P, Heinrich Lindemann C, et al. RESET-PKD: a pilot trial on short-term ketogenic interventions in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2023;38:1623-35. 
  13. Cukoski S, Lindemann CH, Arjune S, Todorova P, Brecht T, Kuhn A, et al. Feasibility and impact of ketogenic dietary interventions in polycystic kidney disease: KETO-ADPKD-a randomized controlled trial. Cell Rep Med 2023;4:101283. 
  14. Kontessis P, Jones S, Dodds R, Trevisan R, Nosadini R, Fioretto P, et al. Renal, metabolic and hormonal responses to ingestion of animal and vegetable proteins. Kidney Int 1990;38:136-44. 
  15. Hansrivijit P, Oli S, Khanal R, Ghahramani N, Thongprayoon C, Cheungpasitporn W. Mediterranean diet and the risk of chronic kidney disease: a systematic review and meta-analysis. Nephrology (Carlton) 2020;25:913-8. 
  16. Podadera-Herreros A, Alcala-Diaz JF, Gutierrez-Mariscal FM, Jimenez-Torres J, Cruz-Ares S, Arenas-de Larriva AP, et al. Long-term consumption of a mediterranean diet or a low-fat diet on kidney function in coronary heart disease patients: the CORDIOPREV randomized controlled trial. Clin Nutr 2022;41:552-9.