Mediterranean diet as the diet of choice for patients with chronic kidney disease
Open accessAbstract
Traditional dietary management of chronic kidney disease (CKD) focuses on the quantity within the diet of energy and protein, and the restriction of single micronutrients, with little mention of dietary quality. Dietary patterns that are more plant-based, lower in meat (including processed meat), sodium and refined sugar, and have a higher content of grains and fibres are now included in multiple clinical guidelines for chronic disease prevention. The Mediterranean diet (MD) has been associated with reduced cardiovascular disease incidence in both observational and interventional studies. A wealth of evidence links MD with other beneficial effects on chronic diseases such as diabetes, obesity or cognitive health. This review examines each constituent of the classical MD and evaluates their suitability for the management of patients with CKD. We also evaluate the potential hyperkalaemia risk of increasing fruit and vegetable intake. Overall, a decrease in net endogenous acid production and increase in fibre may lead to a better control of metabolic acidosis. This, together with other putative favourable effects of MD on endothelial function, inflammation, lipid profile and blood pressure, provide mechanistic pathways to explain the observed reduced renal function decline and improved survival in CKD patients adhering to an MD.
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Overall, the Mediterranean diet has been shown to prevent chronic kidney disease, as well as decrease renal function decline and improve survival in patients with chronic kidney disease.
“Overall, MD has been shown to prevent CKD, as well as decrease renal function decline and improve survival in patients with CKD [69].”
From Mediterranean Diet and Obesity-related Disorders: What is the Evidence? (2022) · cites this paper as [69]
In Mediterranean countries, red meat and processed meats are consumed less than vegetables, fish, and white meat, potentially conveying lower dietary sodium, phosphate, and potassium, which are concerns in CKD.
“Also, in Mediterranean Countries, red meat and processed meats are consumed less than vegetables, fish and white meat, and this may convey a lower amount of dietary sodium, phosphate and potassium, which represent a major concern in patients with CKD due to an intrinsic risk of water-electrolyte decompensation [229].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [229]
The MedDiet has been promoted by ERA-EDTA as the most appropriate choice for the nutritional management of CKD.
“Based on these considerations, the MedDiet has been recently promoted by the European Renal Association–European Dialysis Transplant Association (ERA-EDTA) as the most appropriate choice for the nutritional management of CKD [229].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [229]
High consumption of fresh fruits and vegetables typical of Mediterranean traditions enhances the risk of hyperkalemia in advanced stages of CKD, so low potassium alternatives or boiling cooking methods should be considered when adapting the MedDiet to patients with reduced kidney function.
“However, as underlined by ERA-EDTA itself, the high consumption of fresh fruits and vegetables typical of the Mediterranean traditions and culinarian style, enhances the risk of hyperkalemia in advanced stages of CKD, so that low potassium alternatives or boiling cooking methods should be still cautiously considered when adapting the MedDiet to patients with reduced kidney function [229].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [229]
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- Authors
- Chauveau, P., Aparicio, M., Bellizzi, V., Campbell, K., Hong, X., Johansson, L., Kolko, A., Molina, P., Sezer, S., Wanner, C., ter Wee, P. M., Teta, D., Fouque, D., Carrero, J. J., & European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA)
- Affiliations
- Centre Hospitalier Universitaire de Bordeaux (FR)
- AOU San Giovanni di Dio e Ruggi d'Aragona (IT)
- Bond University (AU)
- Division of Renal Medicine, CLINTEC and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Imperial College Healthcare NHS Trust (GB)
- Association pour l'Utilisation du Rein Artificiel (FR)
- Hospital Universitario Doctor Peset (ES)
- Başkent University Hospital (TR)
- Universitätsklinikum Würzburg (DE)
- Department of Nephrology, VUmc, Amsterdam, The Netherlands
- Centre Hospitalier Universitaire Vaudois (CH)
- Lyon 1 Université (FR)
- Karolinska Institutet (SE)
- Corresponding author
- Chauveau, Philippe
- ORCID
- Venue
- Nephrology Dialysis Transplantation
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-07-02
- Volume
- 33
- Issue
- 5
- Pages
- 725-735
- ISSN
- 0931-0509 (ISSN-L)
- 1460-2385
- OpenAlex
- W2731177409
- Cited by
- 165
- References
- 95
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 16 · 2023: 22 · 2022: 31 · 2021: 33 · 2020: 15 · 2019: 15 · 2018: 4
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Nephrology Dialysis Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Bond University Research Portal (Bond University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- HAL (submittedVersion)
- IRIS (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Griffith Research Online (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- Mediterranean diet, chronic kidney disease, diet quality, plant-based diet, dietary fiber, metabolic acidosis, hyperkalemia, fruit and vegetable intake, cardiovascular disease, endothelial function, inflammation, blood pressure, renal function decline, protein intake
- MeSH terms
- Cardiovascular Diseases, Humans, Prognosis, Diet, Mediterranean, Renal Insufficiency, Chronic
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