PDD | EVIDÊNCIA CIENTÍFICA
NUTRIÇÃO BASEADA EM PLANTAS
Nos últimos anos, um aumento de evidência científica tem surgido sobre os benefícios da dieta à base de plantas (DBP) na prevenção e tratamento de doenças do estilos de vida (obesidade, diabetes, dislipidemia, hipertensão).
Será que as dietas à base de plantas podem beneficiar pessoas com insuficiência renal. A dieta tem sido associada á diminuição da mortalidade, e pode mitigar problemas como obstipação, sobrecarga hídrica, hipernatremia, hipertensão e acidose metabólica, alem de oferecer benefícios da microbiota [flora] intestinal.
KDOQI CLINICAL PRACTICE GUIDELINE FOR NUTRITION IN CKD: 2020 UPDATE
Abstract: The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the first KDOQI nutrition guideline, there has been a great accumulation of new evidence regarding the management of nutritional aspects of kidney disease and sophistication in the guidelines process. The 2020 update to the KDOQI Clinical Practice Guideline for Nutrition in CKD was developed as a joint effort with the Academy of Nutrition and Dietetics (Academy). It provides comprehensive up-to-date information on the understanding and care of patients with chronic kidney disease (CKD), especially in terms of their metabolic and nutritional milieu for the practicing clinician and allied health care workers. The guideline was expanded to include not only patients with end-stage kidney disease or advanced CKD, but also patients with stages 1- 5 CKD who are not receiving dialysis and patients with a functional kidney transplant. The updated guideline statements focus on 6 primary areas: nutritional assessment, medical nutrition therapy (MNT), dietary protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. The guidelines primarily cover dietary management rather than all possible nutritional interventions. The evidence data and guideline statements were evaluated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
THE KEY TO HALTING PROGRESSION OF CKD MIGHT BE IN THE PRODUCE MARKET, NOT IN THE PHARMACY
- Jaime Uribarri, Man S. Oh, The key to halting progression of CKD might be in the produce market, not in the pharmacy, Kidney International, Volume 81, Issue 1, 2012, Pages 7-9, ISSN 0085-2538, https://doi.org/10.1038/ki.2011.331.
Abstract: In vitro, experimental, and clinical work suggests that metabolic acidosis, either directly or indirectly, can promote the progression of chronic kidney disease (CKD). Goraya et al. demonstrate that both oral alkali supplementation and a diet rich in fruits and vegetables are equally effective at decreasing urinary excretion of markers of renal injury in patients with stage 2 CKD. Although this study is promising, the short duration and use of only urinary markers as a surrogate outcome weaken the conclusions.
Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe
- Gluba-Brzózka, A., Franczyk, B., & Rysz, J. (2017). Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe. Nutrients, 9(4), 374. MDPI AG. Retrieved from http://dx.doi.org/10.3390/nu9040374
Abstract: Healthy diet is highly important, especially in patients with chronic kidney disease (CKD). Proper nutrition provides the energy to perform everyday activities, prevents infection, builds muscle, and helps to prevent kidney disease from getting worse. However, what does a proper diet mean for a CKD patient? Nutrition requirements differ depending on the level of kidney function and the presence of co-morbid conditions, including hypertension, diabetes, and cardiovascular disease. The diet of CKD patients should help to slow the rate of progression of kidney failure, reduce uremic toxicity, decrease proteinuria, maintain good nutritional status, and lower the risk of kidney disease-related secondary complications (cardiovascular disease, bone disease, and hypertension). It has been suggested that plant proteins may exert beneficial effects on blood pressure, proteinuria, and glomerular filtration rate, as well as results in milder renal tissue damage when compared to animal proteins. The National Kidney Foundation recommends vegetarianism, or part-time vegetarian diet as being beneficial to CKD patients. Their recommendations are supported by the results of studies demonstrating that a plant-based diet may hamper the development or progression of some complications of chronic kidney disease, such as heart disease, protein loss in urine, and the progression of kidney damage. However, there are sparse reports suggesting that a vegan diet is not appropriate for CKD patients and those undergoing dialysis due to the difficulty in consuming enough protein and in maintaining proper potassium and phosphorus levels. Therefore, this review will focus on the problem as to whether vegetarian diet and its modifications are suitable for chronic kidney disease patients.
A Plant-Based Diet Prevents and Treats Chronic Kidney Disease
- Rose, Stewart & Strombom, Amanda. (2019). JOJ uro & nephron A Plant-Based Diet Prevents and Treats Chronic Kidney Disease. 10.19080/JOJUN.2019.06.555687.
Abstract: Interest in the dietary treatment of chronic kidney disease has been growing as its incidence has been increasing. Chronic Kidney Disease (CKD) is now the 8th leading cause of death in the United States and its treatment consumes substantial amounts of medical resources and money. Several lines of epidemiological research have shown a lower risk of chronic kidney disease among vegetarians. It also shows a substantially increased risk among omnivores, especially those who eat red and processed meats. Although the practice started long ago, research on the use of a low-protein plant-based diet to treat chronic kidney disease diet has intensified in recent years. This research has shown that a low-protein vegetarian diet is safe and efficacious at both treating and slowing the progression of chronic kidney disease. Treatment with a low-protein vegetarian diet, often supplemented with keto analogues, has been shown to reduce acidosis, phosphotemia, uremia, proteinuria and to slow progression. Research shows that this treatment does not result in malnutrition. Research has also shown that larger amounts of plant protein than animal protein can be consumed, without deleterious effects. Treatment with a low protein vegetarian diet also has the advantage of preventing and treating common comorbidities such as type 2 diabetes and coronary artery disease.
Vegetable-Based Diets for Chronic Kidney Disease? It Is Time to Reconsider
- Cases, A., Cigarrán-Guldrís, S., Mas, S., & Gonzalez-Parra, E. (2019). Vegetable-Based Diets for Chronic Kidney Disease? It Is Time to Reconsider. Nutrients, 11(6), 1263. MDPI AG. http://dx.doi.org/10.3390/nu11061263
Abstract: Traditional dietary recommendations to renal patients limited the intake of fruits and vegetables because of their high potassium content. However, this paradigm is rapidly changing due to the multiple benefits derived from a fundamentally vegetarian diet such as, improvement in gut dysbiosis, reducing the number of pathobionts and protein-fermenting species leading to a decreased production of the most harmful uremic toxins, while the high fiber content of these diets enhances intestinal motility and short-chain fatty acid production. Metabolic acidosis in chronic kidney disease (CKD) is aggravated by the high consumption of meat and refined cereals, increasing the dietary acid load, while the intake of fruit and vegetables is able to neutralize the acidosis and its deleterious consequences. Phosphorus absorption and bioavailability is also lower in a vegetarian diet, reducing hyperphosphatemia, a known cause of cardiovascular mortality in CKD. The richness of multiple plants in magnesium and vitamin K avoids their deficiency, which is common in these patients. These beneficial effects, together with the reduction of inflammation and oxidative stress observed with these diets, may explain the reduction in renal patients’ complications and mortality, and may slow CKD progression. Finally, although hyperkalemia is the main concern of these diets, the use of adequate cooking techniques can minimize the amount absorbed.
Vegetarian diets and chronic kidney disease
- Philippe Chauveau, Laetitia Koppe, Christian Combe, Catherine Lasseur, Stanislas Trolonge, Michel Aparicio, Vegetarian diets and chronic kidney disease, Nephrology Dialysis Transplantation, Volume 34, Issue 2, February 2019, Pages 199–207, https://doi.org/10.1093/ndt/gfy164
Abstract: While dietary restriction of protein intake has long been proposed as a possible kidney-protective treatment, the effects of changes in the quality of ingested proteins on the prevalence and risk of progression of chronic kidney disease (CKD) have been scarcely studied; these two aspects are reviewed in the present article. The prevalence of hypertension, type 2 diabetes and metabolic syndrome, which are the main causes of CKD in Western countries, is lower in vegetarian populations. Moreover, there is a negative relationship between several components of plant-based diets and numerous factors related to CKD progression such as uraemic toxins, inflammation, oxidative stress, metabolic acidosis, phosphate load and insulin resistance. In fact, results from different studies seem to confirm a kidney-protective effect of plant-based diets in the primary prevention of CKD and the secondary prevention of CKD progression. Various studies have determined the nutritional safety of plant-based diets in CKD patients, despite the combination of a more or less severe dietary protein restriction. As observed in the healthy population, this dietary pattern is associated with a reduced risk of all-cause mortality in CKD patients. We propose that plant-based diets should be included as part of the clinical recommendations for both the prevention and management of CKD
Adequacy of Plant-Based Proteins in Chronic Kidney Disease
- Shivam Joshi, Sanjeev Shah, Kamyar Kalantar-Zadeh, Adequacy of Plant-Based Proteins in Chronic Kidney Disease, Journal of Renal Nutrition, Volume 29, Issue 2, 2019, Pages 112-117, ISSN 1051-2276,
Abstract: Concerns regarding protein and amino acid deficiencies with plant-based proteins have precluded their use in chronic kidney disease (CKD) patients. Many of these concerns were debunked years ago, but recommendations persist regarding the use of “high-biological value” (animal-based) proteins in CKD patients, which may contribute to worsening of other parameters such as blood pressure, metabolic acidosis, and hyperphosphatemia. Plant-based proteins are sufficient in meeting both quantity and quality requirements. Those eating primarily plant-based diets have been observed to consume approximately 1.0 g/kg/day of protein, or more. CKD patients have been seen to consume 0.7-0.9 g/kg/day of mostly plant-based protein without any negative effects. Furthermore, those substituting animal-based proteins for plant-based proteins have shown reductions in severity of hypertension, hyperphosphatemia, and metabolic acidosis. Plant-based proteins, when consumed in a varied diet, are not only nutritionally adequate but have pleiotropic effects which may favor their use in CKD patients.
Plant-Based Diets For Prevention and Management Of Chronic Kidney Disease
- Joshi, Shivama,b; Hashmi, Seanc; Shah, Sanjeevd; Kalantar-Zadeh, Kamyare Plant-based diets for prevention and management of chronic kidney disease, Current Opinion in Nephrology and Hypertension: January 2020 - Volume 29 - Issue 1 - p 16-21
Purpose of review: Plant-based diets have been used with growing popularity for the treatment of a wide range of lifestyle-related diseases, including diabetes, hypertension, and obesity. With the reinvigoration of the dietary management of chronic kidney disease (CKD) and the use of low protein diets for secondary prevention of CKD to delay or prevent dialysis therapy, there is an increasing interest in the potential role of plant-based diets for these patients.
Recent findings: Recently, a body of evidence related to the role of plant-based diets in preventing CKD has reemerged. Several observational studies have shown that red and processed meat have been associated with increased risk of CKD as well as faster progression in those with preexisting CKD. In several substitution analyses, replacement of one serving of red and/or processed meat has been linked with sizable reductions in CKD risk. Although limited, experimental trials for the treatment of metabolic acidosis in CKD with fruits and vegetables show outcomes comparable to oral bicarbonate. The use of plant-based diets in CKD may have other benefits in the areas of hypertension, weight, hyperphosphatemia, reductions in hyperfiltration, and, possibly, mortality. The risk of potassium overload from plant-based diets appears overstated, mostly opinion-based, and not supported by the evidence. Plant-based diets are generally well tolerated and provide adequate protein intake, including essential amino acids as long as the diet is correctly implemented.
Summary: Plant-based diets should be recommended for both primary and secondary prevention of CKD. Concerns of hyperkalemia and protein inadequacy related to plant-based diets may be outdated and unsupported by the current body of literature. Healthcare providers in general medicine and nephrology can consider plant-based diets as an important tool for prevention and management of CKD.
Plant-based diets to manage the risks and complications of chronic kidney disease
- Carrero, J. J., González-Ortiz, A., Avesani, C. M., Bakker, S., Bellizzi, V., Chauveau, P., Clase, C. M., Cupisti, A., Espinosa-Cuevas, A., Molina, P., Moreau, K., Piccoli, G. B., Post, A., Sezer, S., & Fouque, D. (2020). Plant-based diets to manage the risks and complications of chronic kidney disease. Nature reviews. Nephrology, 16(9), 525–542. https://doi.org/10.1038/s41581-020-0297-2
Abstract: 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.
PLANT-BASED DIETS AND HYPERTENSION
- Joshi, S., Ettinger, L., & Liebman, S. E. (2020). Plant-Based Diets and Hypertension. American Journal of Lifestyle Medicine, 14(4), 397–405. https://doi.org/10.1177/1559827619875411
Abstract: Hypertension is a global epidemic and a risk factor for many adverse outcomes, including cardiovascular disease, kidney disease, and death. Lifestyle plays a significant role in the development and maintenance of hypertension, and guidelines from several organizations recommend lifestyle modifications as first-line intervention for hypertensive patients. Data supporting the use of plant-based diets in the treatment of hypertension goes back almost a century. More recently, clinical trial data, including randomized controlled trials, have established plant-based diets as an effective lifestyle intervention for high blood pressure (BP). Plant-based diets differ from the standard American diet in a myriad of ways, with some substances being present in either substantially higher or lower amounts. Although the precise mechanism of a plant-based diet’s beneficial effects on BP is unknown, many of these differences may be responsible. Attributes of a plant-based diet that may lower BP include a lower energy content leading to weight loss, a lower sodium content, an increased potassium content, reduced oxidative stress, higher bioavailability of the vasodilator nitric oxide, and beneficial effects on the microbiome. The evidenced-based benefits of plant-based diets in treating hypertension should lead providers to advocate for this dietary pattern for their patients.
Plant-Based Diets for Kidney Disease: A Guide for Clinicians, American Journal of Kidney Diseases.
- Shivam Joshi, Michelle McMacken, Kamyar Kalantar-Zadeh, Plant-Based Diets for Kidney Disease: A Guide for Clinicians, American Journal of Kidney Diseases, Volume 77, Issue 2, 2021, Pages 287-296, ISSN 0272-6386, https://doi.org/10.1053/j.ajkd.2020.10.003.
Abstract: In recent years, a growing body of evidence has emerged on the benefits of plant-based diets for the prevention and treatment of lifestyle diseases. In parallel, data now exist regarding the treatment of chronic kidney disease and its most common complications with this dietary pattern. Improving the nutrient quality of foods consumed by patients by including a higher proportion of plant-based foods while reducing total and animal protein intake may reduce the need for or complement nephroprotective medications, improve kidney disease complications, and perhaps favorably affect disease progression and patient survival. In this In Practice article, we review the available evidence on plant-dominant fiber-rich diet as it relates to kidney disease prevention, chronic kidney disease incidence and progression, metabolic acidosis, hyperphosphatemia, hypertension, uremic toxins, need for kidney replacement therapy including dialysis, patient satisfaction and quality of life, and mortality. Further, concerns of hyperkalemia and protein inadequacy, which are often associated with plant-based diets, are also reviewed in the context of available evidence. It is likely that the risks for both issues may not have been as significant as previously thought, while the advantages are vast. In conclusion, the risk to benefit ratio of plant-based diets appears to be tilting in favor of their more prevalent use. Keywords: Plant-based diets; plant-based foods; chronic kidney disease (CKD); plant protein; lifestyle; animal protein; dietary pattern; modifiable risk factor; CKD prevention; dietary acid load; renal function; review.
TAKING THE KALE OUT OF HYPERKALEMIA: PLANT FOODS AND SERUM POTASSIUM IN PATIENTS WITH KIDNEY DISEASE
- John S. Babich, Kamyar Kalantar-Zadeh, Shivam Joshi, Taking the Kale out of Hyperkalemia: Plant Foods and Serum Potassium in Patients With Kidney Disease,
Journal of Renal Nutrition, 2022, ISSN 1051-2276,
Abstract: Traditionally, diets for kidney disease were low in potassium. This recommendation was based on outdated research and often wrong assumptions that do not reflect current evidence. In fact, studies conducted over the past decades show patients with CKD, including kidney failure, do not benefit from the restriction of plant foods relative to control. Generally, dietary potassium does not correlate with serum potassium, and we posit that this is due to the effects of fiber on colonic potassium absorption, the alkalinizing effect of fruits and vegetables on metabolic acidosis, and the bioavailability of dietary potassium in plant foods. Also, consumption of plant foods may provide pleiotropic benefits to patients with CKD. Emerging dietary recommendations for kidney health should be devoid of dietary potassium restrictions from plant foods so that patient-centered kidney recipes can be encouraged and promoted.
Publicado por: 🌱 au_tavares | 2021-05-29 | Última atualização: em atualização