Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Nutrients. 2023 Feb 16;15(4):1002. doi: 10.3390/nu15041002.
Dietary protein restriction has long been a cornerstone of nutritional therapy for patients with chronic kidney diseases (CKD). However, the recommended amount of dietary protein intake is different across guidelines. This is partly because previous randomized controlled trials have reported conflicting results regarding the efficacy of protein restriction in terms of kidney outcomes. Interestingly, a vegetarian, very low protein diet has been shown to reduce the risk of kidney failure among patients with advanced CKD, without increasing the incidence of hyperkalemia. This finding suggests that the source of protein may also influence the kidney outcomes. Furthermore, a plant-dominant low-protein diet (PLADO) has recently been proposed as an alternative dietary therapy for patients with CKD. There are several potential mechanisms by which plant-based diets would benefit patients with CKD. For example, plant-based diets may reduce the production of gut-derived uremic toxins by increasing the intake of fiber, and are useful for correcting metabolic acidosis and hyperphosphatemia. Plant proteins are less likely to induce glomerular hyperfiltration than animal proteins. Furthermore, plant-based diets increase magnesium intake, which may prevent vascular calcification. More evidence is needed to establish the efficacy, safety, and feasibility of PLADO as a new adjunct therapy in real-world patients with CKD.
饮食蛋白质限制一直是慢性肾脏病（CKD）患者营养治疗的基石。然而，不同指南中推荐的饮食蛋白质摄入量不同。这在一定程度上是因为先前的随机对照试验报告了关于蛋白质限制在肾脏结局方面的疗效的相互矛盾的结果。有趣的是，素食、极低蛋白饮食已被证明可降低晚期 CKD 患者肾衰竭的风险，而不会增加高钾血症的发生率。这一发现表明，蛋白质的来源也可能影响肾脏结局。此外，最近提出了以植物为主的低蛋白饮食（PLADO）作为 CKD 患者的另一种饮食治疗方法。植物性饮食可能通过增加纤维的摄入来减少肠道来源的尿毒症毒素的产生，并且有助于纠正代谢性酸中毒和高磷血症。植物蛋白比动物蛋白更不容易引起肾小球高滤过。此外，植物性饮食增加了镁的摄入，这可能预防血管钙化。需要更多的证据来确定 PLADO 作为 CKD 真实世界患者新辅助治疗的疗效、安全性和可行性。
