Dietary Patterns, Foods and Beverages in Chronic Kidney Disease

Abstract

The prevalence of chronic kidney disease (CKD) is high (estimated 200 million people worldwide) and steadily increasing, especially in older populations, and it is associated with increased risk of renal cancer, cardiovascular disease, and bone disorders and fractures. The Western diet is associated with increased renal dysfunction, CKD risk and progression to end stage renal disease (ESRD). A healthy diet for CKD patients should help to slow the rate of progression of kidney failure, reduce uremic toxicity, decrease proteinuria, and lower the risk of secondary complications including cardiovascular disease, bone disease, and hypertension. Lower dietary energy density and higher fiber healthy dietary patterns can play a role in lowering the risk of CKD. Protein sources vary in their effect on CKD risk with red and processed meat consumption significantly increasing risk whereas higher intake of nuts, legumes, and low-fat dairy products may lower risk. Increased fiber intake triggers a number of physiologic processes in both the colon microbiota and systemically that support the detoxification of the kidneys, via influences on the gut barrier, gastrointestinal immune and endocrine responses, nitrogen cycling, and microbial metabolism which alter the physiology and biochemistry of the kidneys to help re-establish homeostasis. Healthy dietary patterns including fiber-rich whole-grains, fruits and vegetables may improve renal function, and decrease metabolic acidosis compared to poor quality diets low in fruits and vegetables and high in processed foods and animal products. High adherence to healthy dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH), especially a modified version of the DASH diet for people with CKD, and the Mediterranean diet (MedDiet) may help to reduce CKD risk, progression to later stages and mortality.

Appendix A:

Fifty high fiber whole or minimally processed plant foods ranked by amount of fiber per standard food portion size

Food	Standard portion size	Dietary fiber (g)	Calories (kcal)	Energy density (calories/g)
High fiber bran ready-to-eat-cereal	1/3–3/4 cup (30 g)	9.1–14.3	60–80	2.0–2.6
Navy beans, cooked	1/2 cup cooked (90 g)	9.6	127	1.4
Small white beans, cooked	1/2 cup (90 g)	9.3	127	1.4
Shredded wheat ready-to-eat cereal	1–1 1/4 cup (50-60 g)	5.0–9.0	155–220	3.2–3.7
Black bean soup, canned	1/2 cup (130 g)	8.8	117	0.9
French beans, cooked	1/2 cup (90 g)	8.3	114	1.3
Split peas, cooked	1/2 cup (100 g)	8.2	114	1.1
Chickpeas (Garbanzo) beans, canned	1/2 cup (120 g)	8.1	176	1.4
Lentils, cooked	1/2 cup (100 g)	7.8	115	1.2
Pinto beans, cooked	1/2 cup (90 g)	7.7	122	1.4
Black beans, cooked	1/2 cup (90 g)	7.5	114	1.3
Artichoke, global or French, cooked	1/2 cup (84 g)	7.2	45	0.5
Lima beans, cooked	1/2 cup (90 g)	6.6	108	1.2
White beans, canned	1/2 cup (130 g)	6.3	149	1.1
Wheat bran flakes ready-to-eat cereal	3/4 cup (30 g)	4.9–5.5	90–98	3.0–3.3
Pear with skin	1 medium (180 g)	5.5	100	0.6
Pumpkin seeds. whole, roasted	1 ounce (about 28 g)	5.3	126	4.5
Baked beans, canned, plain	1/2 cup (125 g)	5.2	120	0.9
Soybeans, cooked	1/2 cup (90 g)	5.2	150	1.7
Plain rye wafer crackers	2 wafers (22 g)	5.0	73	3.3
Avocado, Hass	1/2 fruit (68 g)	4.6	114	1.7
Apple, with skin	1 medium (180 g)	4.4	95	0.5
Green peas, cooked (fresh, frozen, canned)	1/2 cup (80 g)	3.5–4.4	59–67	0.7–0.8
Refried beans, canned	1/2 cup (120 g)	4.4	107	0.9
Mixed vegetables, cooked from frozen	1/2 cup (45 g)	4.0	59	0.7
Raspberries	1/2 cup (65 g)	3.8	32	0.5
Blackberries	1/2 cup (65 g)	3.8	31	0.4
Collards, cooked	1/2 cup (95 g)	3.8	32	0.3
Soybeans, green, cooked	1/2 cup (75 g)	3.8	127	1.4
Prunes, pitted, stewed	1/2 cup (125 g)	3.8	133	1.1
Sweet potato, baked	1 medium (114 g)	3.8	103	0.9
Multi-grain bread	2 slices regular (52 g)	3.8	140	2.7
Figs, dried	1/4 cup (about 38 g)	3.7	93	2.5
Potato baked, with skin	1 medium (173 g)	3.6	163	0.9
Popcorn, air-popped	3 cups (24 g)	3.5	93	3.9
Almonds	1 ounce (about 28 g)	3.5	164	5.8
Whole wheat spaghetti, cooked	1/2 cup (70 g)	3.2	87	1.2
Sunflower seed kernels, dry roasted	1 ounce (about 28 g)	3.1	165	5.8
Orange	1 medium (130 g)	3.1	69	0.5
Banana	1 medium (118 g)	3.1	105	0.9
Oat bran muffin	1 small (66 g)	3.0	178	2.7
Vegetable soup	1 cup (245 g)	2.9	91	0.4
Dates	1/4 cup (about 38 g)	2.9	104	2.8
Pistachios, dry roasted	1 ounce (about 28 g)	2.8	161	5.7
Hazelnuts or filberts	1 ounce (about 28 g)	2.7	178	6.3
Peanuts, oil roasted	1 ounce (about 28 g)	2.7	170	6.0
Quinoa, cooked	1/2 cup (90 g)	2.7	92	1.0
Broccoli, cooked	1/2 cup (78 g)	2.6	27	0.3
Potato baked, without skin	1 medium (145 g)	2.3	145	1.0
Baby spinach leaves	3 ounces (90 g)	2.1	20	0.2
Blueberries	1/2 cup (74 g)	1.8	42	0.6
Carrot, raw or cooked	1 medium (60 g)	1.7	25	0.4

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