Effect of vegetarian diets on renal function in patients with chronic kidney disease under non-dialysis treatment: A scoping review

Valim, Agnes; Carpes, Larissa Salomoni; Nicoletto, Bruna Bellincanta

doi:10.1590/2175-8239-JBN-2021-0126

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Brazilian Journal of Nephrology

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Review Article • Braz. J. Nephrol. 44 (3) • Jul-Sep 2022 • https://doi.org/10.1590/2175-8239-JBN-2021-0126 copy

Effect of vegetarian diets on renal function in patients with chronic kidney disease under non-dialysis treatment: A scoping review

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Abstract

Vegetable protein diets (VPDs) in chronic kidney disease (CKD) patients may be related to beneficial biological actions and possibly clinical impact. This is a scoping review that merge studies that evaluated the effect of a vegetarian diet on kidney function in adults with CKD under non-dialysis treatment. The evaluated outcome was the impact in renal function assessed by eGFR or creatinine clearance. MEDLINE (accessed by PubMed) was searched up to September 8, 2020. Data were extracted by two independent reviewers, who also assessed the quality of the studies. Of 341 retrieved articles, 4 studies assessing 324 patients were included in the analysis. One study showed that a very low-protein ketoanalogue-supplemented vegetarian diet had benefits in relation to a conventional low-protein diet, while the other three studies demonstrated no difference in kidney function between the evaluated diets. Additional studies are needed to assess the benefits of vegetarian diets for further recommendations in CKD management.

Keywords:
Diet; Vegetarian; Renal Insufficiency; Chronic; Conservative Treatment

Study (year)	Design	Objective	Intervention and control groups	Follow-up length	Stage of CKD	eGFR or creatinine clearance	Age (years)	Sex	BMI (kg/m²)	Outcomes and results
Chang et al. (2018). Taiwan.	Cross- sectional study.	To investigate the effects of different proportions and sources of protein in lacto- ovo vegetarian and omnivorous diets, as well as the influence of adequate dietary protein intake, on renal function and nutritional status of Taiwanese patients.	I: 40 (lacto- ovo vegetarians)	Outpatients who visited the Department of Nephrology and Nutrition at Chung Shan Medical University Hospital between June 2011 and May 2015 were enrolled.	Stages 3 to 5.	eGFR: 21.7 ± 12.1 mL/min/1.73 m²	68.3 ± 11.9	Male: 37.5% Female: 2.5%	23.3 ± 3.5	The indicators of renal function including eGFR were not significantly different between lacto-ovo vegetarian and omnivorous patients with CKD (p= 0.305).
Chang et al. (2018). Taiwan.	Cross- sectional study.		C: 60 (omnivores)		Stages 3 to 5.	eGFR: 24.6 ± 14.9 mL/min/1.73 m²	64.4 ± 13.7	Male: 55% Female: 45%	24.9 ± 3.7
Garneata et al. (2016). Romênia.	Prospective, randomized, controlled trial.	To evaluate safety and efficacy of very low-protein ketoanalogue-supplemented vegetarian diet (KD) compared with conventional low-protein diet (LPD).	I: 104 (KD)	15 months	Stages 4 and 5.	eGFR: Baseline: 18.0 (15.5 to 20.1) mL/min/1.73m2 End of study: 15.1 (13.2 to 17.4) mL/min/1.73m²	55.2	Male: 63% Female: 37%	23.6 (23.1 to 24.2)	A significant lower percentage of patients in the KD group reached the primary end point (RRT initiation or a >50% reduction in the initial eGFR): 13% versus 42% in the LPD group (P<0.001). The difference between arms was >10%. RRT initiation was required in a lower proportion in the KD group (11% versus 30%; P<0.001).
Garneata et al. (2016). Romênia.	Prospective, randomized, controlled trial.		C: 103 (LPD)	15 months	Stages 4 and 5.	eGFR: Baseline: 17.9 (14.3 to 19.3) mL/min/1.73m² End of study: 10.8 (9.0 to 12.2) mL/min/1.73m²	53.6	Male: 59% Female: 41%	23.2 (22.7 to 23.7)
Moe et al. (2010) Estados Unidos.	Crossover trial.	To determine if the dietary protein source of phosphate influences phosphorus metabolism and hormonal changes in humans because this would affect dietary recommendations.	I: 8 (Vegetarian diet) C: 8 (Meat diet)	7 days	Stage late 3 or stage 4.	CCr Before intervention: 43 ± 11 mL/min After intervention: 44 ± 16 mL/min CCr Before intervention: 47 ± 16 mL/min After intervention: 47 ± 16 mL/min	61 ± 8.4 61 ± 8.4	Male: 4 Female: 4 Male: 4 Female: 4	32 ± 5 32 ± 5	There was no difference in creatinine between the two diets (P: NS).
Soroka et al. (1998) Israel.	Randomized crossover design.	To compare the effect of a soya-based vegetarian low-protein diet (VPD) and an animal-based low- protein diet in patients with moderate to severe CKD.	I: 9 (vegetarian low-protein diet) C: 9 (animal- based low- protein diet)	6 months	The creatinine clearance (CCr) had to be between 15 and 50 mL/min/1.73 m² and the 24- hour urinary protein excretion <3 g/day.	CCr: 25.09 ± 2.9 mL/min/1.73 m² (end of 6 months) CCr: 28.62 ± 4.0 mL/min/1.73 m² (end of 6 months)	30-85 30-85	Male: 5 Female: 4 Male: 5 Female: 4	NA NA	There were no significant differences between the groups (P > 0.05).

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[1] Correspondence to: Bruna Bellincanta Nicoletto. E-mail: bbngehrke@ucs.br