Rethinking Nutrition in Chronic Kidney Disease: Plant Foods, Bioactive Compounds, and the Shift Beyond Traditional Limitations: A Narrative Review

The incidence of chronic kidney disease (CKD) has increased worldwide in recent years. Many factors can contribute to the progression of CKD, some of which are dietary patterns. Adequate control of protein, phosphorus, potassium, and sodium intake can significantly slow the progression of CKD. Most studies and nutritional guidelines addressing the care of people with CKD have focused primarily on dietary recommendations regarding macronutrient intake and the restriction of individual micronutrients. Traditionally, the consumption of fiber-rich fruits and vegetables has been restricted in patients with CKD to combat hyperkalemia. Among the reasons often given for this restriction are concerns about their high potassium and phosphorus contents. Limiting the intake of whole grains in CKD patients has also been recommended. However, findings indicate that phosphorus in plant foods is not fully absorbed in humans. Potassium contribution from vegetables can be reduced by culinary treatments, and when highly insoluble fiber is present in vegetables, it promotes potassium excretion through the intestine, which could help control the risk of hyperkalemia in CKD patients. Other recent findings have shown beneficial effects of vegetable bioactive compounds and resistant starch on CKD patients. The aim of the present review was to compile and discuss traditional recommendations for the use of plant-based foods for patients with CKD, as well as the mechanisms through which such foods may contribute to improving CKD progression.