March 06, 2022
1 minute read
Joshi S, Kidney life plan: do plant-based diets provide adequate nutrition and better phosphate control in dialysis patients? Presented at: Annual Dialysis Conference; March 4-6, 2022 (virtual meeting).
Disclosures: Joshi is a consultant for Insyght Interactive, Vifor Pharma and Otsuka.
Plant-based diets may be a helpful strategy for dialysis patients to lower their phosphorus levels, according to a speaker at the annual virtual dialysis conference.
“Plant-based diets have historically been avoided or overlooked in the use of our kidney disease patients, particularly those on dialysis, for a variety of reasons including issues with potassium and inadequate protein,” Shivam Joshi, MD, said a clinical assistant professor of medicine at Bellevue Hospital and NYU Grossman School of Medicine. “However, recent research suggests that this risk may be overestimated.”
According to Joshi, plant-based diets can include a flexible diet that doesn’t cut out all animal products, but limits intake compared to the standard American diet. Therefore, Joshi said, it’s possible to follow a plant-based diet on dialysis and get enough protein. Likewise, the risk of consuming too much protein is unlikely because plant-derived phosphate is mostly bound in the form of phytates, which means it is not absorbable.
“It’s possible to take any diet and make it unhealthy or inadequate,” Joshi said.
Joshi referenced a study that showed that plant-based foods that report high levels of potassium are often juices, sauces and dried fruits, but not unprocessed plant-based foods. Factors that may reduce an increase in serum potassium in patients with end-stage renal disease on a plant-based diet include fiber, colonic potassium secretion, intracellular movement of potassium, and bioavailability.
Another study referenced by Joshi compared serum phosphate levels in vegetarian and non-vegetarian patients with ESKD. The results showed that vegetarian patients had significantly lower serum phosphate levels.
“Maintaining protein while reducing phosphorus can be achieved through a plant-based diet due to the low bioavailability of these foods, especially if unprocessed, the low phosphomimic index of these foods. plant-based diets may provide less protein than animal-based diets or the standard American diet, but overall have not been shown to affect nutrition or cause any deficiency. Potassium levels do not appear to increase in those consuming a plant-based diet while on dialysis,” Joshi said. “Further research is definitely needed.”