Multiple agencies, including the National Kidney Foundation (NKF), recommend the use of plant-based diets to prevent heart disease and hypertension, as well as delay the progression of chronic kidney disease (CKD). In a 2019 article in the Clinical Journal of the Society of Nephrology, researchers analyze the benefits and potential risks of plant-based diets on kidney health.*

Benefits of a plant-based diet

Plant-based diets tend to be high in fiber and low in saturated fat and processed meats. They also contain sources of potassium, phosphorus, magnesium, and calcium, in addition to low levels of sodium. These nutritional qualities lead to a reduction in the risk of developing cardiovascular disease (CVD) and chronic kidney disease.

Research shows that people who consume a meat-based diet and show elevated acid loads had a higher risk of progression to end-stage kidney disease (ESKD) than participants with a lower calculated dietary acid load. Diets high in fruits and vegetables tend to have an alkalizing effect, reducing the acid load.

Other benefits include:

• Data showed that a higher ratio of plant to total protein was associated with a lower risk of mortality among participants with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min per 1.73 m2.
• Plant-based diets are also associated with a 12% lower risk of decline in eGFR when compared with meat-based diets.
• In a study of participants older than 70 years of age, with asymptomatic uremia (a condition that occurs when the kidneys are no longer filtering properly), and an eGFR of 5–7 ml/min per 1.73 m2 who ate a vegan diet were found to have dialysis delayed for about a year.

Potential risks of a plant-based diet in CKD patients

There are concerns that plant-based diets may lead to a decreased ability to remove phosphorus and an increased intake of potassium. According to the American Kidney Fund (AKF), healthy kidneys balance the potassium and phosphorus in your body, but when suffering from kidney disease, kidneys may be unable to remove both nutrients—leading to a build-up of dangerous levels in the blood.

Having too much phosphorus in the blood is a condition called hyperphosphatemia, and abnormally high levels of potassium lead to hyperkalemia. Hyperphosphatemia can lead to bone disease, whereas hyperkalemia can lead to heart problems.

Caution should be taken when deciding whether to prescribe a plant-based diet to those with remaining kidney function that is inadequate to avoid the potentially detrimental effects of hyperphosphatemia and hyperkalemia. In regards to hyperkalemia, more research is needed on potassium binder medications and their ability to safely allow those with compromised kidney function to reap the many benefits of a plant-based diet while maintaining balanced levels of potassium.

Despite growing evidence that plant-based diets in those with an eGFR of 30–59 ml/min per 1.73 m2 may delay progression to ESKD and dialysis and improve survival, larger studies are needed to confirm these findings. It is also necessary to take into consideration the implications of one’s socioeconomic status in their ability to both access and afford oftentimes expensive plant-based diets.

*Clegg, D. J., & Hill Gallant, K. M. (2018). Plant-Based Diets in CKD. Clinical Journal of the American Society of Nephrology, 14(1), 141–143. https://doi.org/10.2215/cjn.08960718