Plant-based diets to manage the risks and complications of chronic kidney disease

Nat Rev Nephrol. 2020 Sep;16(9):525-542. doi: 10.1038/s41581-020-0297-2. Epub 2020 Jun 11.


Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acid-Base Equilibrium
  • Diet, Healthy
  • Diet, Mediterranean
  • Diet, Vegetarian*
  • Dietary Approaches To Stop Hypertension
  • Dietary Fats, Unsaturated
  • Dietary Fiber
  • Disease Progression
  • Humans
  • Hyperkalemia / etiology
  • Phosphorus, Dietary
  • Plant Proteins, Dietary
  • Potassium, Dietary / adverse effects
  • Renal Dialysis
  • Renal Insufficiency, Chronic / diet therapy*
  • Renal Insufficiency, Chronic / metabolism


  • Dietary Fats, Unsaturated
  • Dietary Fiber
  • Phosphorus, Dietary
  • Plant Proteins, Dietary
  • Potassium, Dietary