Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease
Open accessAbstract
BACKGROUND AND OBJECTIVES: Patients with advanced chronic kidney disease (CKD) are in positive phosphorus balance, but phosphorus levels are maintained in the normal range through phosphaturia induced by increases in fibroblast growth factor-23 (FGF23) and parathyroid hormone (PTH). This provides the rationale for recommendations to restrict dietary phosphate intake to 800 mg/d. However, the protein source of the phosphate may also be important. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a crossover trial in nine patients with a mean estimated GFR of 32 ml/min to directly compare vegetarian and meat diets with equivalent nutrients prepared by clinical research staff. During the last 24 hours of each 7-day diet period, subjects were hospitalized in a research center and urine and blood were frequently monitored. RESULTS: The results indicated that 1 week of a vegetarian diet led to lower serum phosphorus levels and decreased FGF23 levels. The inpatient stay demonstrated similar diurnal variation for blood phosphorus, calcium, PTH, and urine fractional excretion of phosphorus but significant differences between the vegetarian and meat diets. Finally, the 24-hour fractional excretion of phosphorus was highly correlated to a 2-hour fasting urine collection for the vegetarian diet but not the meat diet. CONCLUSIONS: In summary, this study demonstrates that the source of protein has a significant effect on phosphorus homeostasis in patients with CKD. Therefore, dietary counseling of patients with CKD must include information on not only the amount of phosphate but also the source of protein from which the phosphate derives.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a trial, participants on diets with equivalent nutrient content had lower serum phosphorus and phosphorus excretion when the protein source was vegetarian compared to animal-based.
“participants on diets with equivalent nutrient content had lower serum phosphorus and phosphorus excretion when the protein source was vegetarian as compared to animal-based [103].”
From Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function (2020) · cites this paper as [103]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
Block, G. A., Klassen, P., Lazarus, J. M., Ofsthun, N. J., Lowrie, E. G., & Chertow, G. M. (2004) · Journal of the American Society of Nephrology · doi:10.1097/01.asn.0000133041.27682.a2 · Cited by 2,684 · see citing works
K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease
Massry, S. G., Coburn, J. W., Chertow, G. M., Hruska, K. A., Langman, C. B., Malluche, H. H., Martin, K. J., McCann, L. M., McCarthy, J. T., Moe, S. M., et al. (2003) · University of Groningen research database (University of Groningen / Centre for Information Technology) · Cited by 2,527 · see citing works
Self-citationBone metabolism and disease in chronic kidney disease
Eknoyan, G., Levin, A., & Levin, N. W. (2003) · American Journal of Kidney Diseases · doi:10.1016/s0272-6386(03)00905-3 · Cited by 1,287 · see citing works
Serum Phosphate Levels and Mortality Risk among People with Chronic Kidney Disease
Kestenbaum, B. R., Sampson, J. N., Rudser, K. D., Patterson, D. J., Seliger, S. L., Young, B. A., Sherrard, D. J., & Andress, D. L. (2004) · Journal of the American Society of Nephrology · doi:10.1681/asn.2004070602 · Cited by 1,224 · see citing works
Eckardt, K., & Kasiske, B. L. (2009) · Kidney International · doi:10.1038/ki.2009.188 · Cited by 1,168 · see citing works
K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease.
(2003) · PubMed · Cited by 1,052 · see citing works
The parathyroid is a target organ for FGF23 in rats
Ben‐Dov, I. Z., Galitzer, H., Lavi-Moshayoff, V., Goetz, R. M., Kuro‐o, M., Mohammadi, M., Sirkis, R., Naveh‐Many, T., & Silver, J. (2007) · Journal of Clinical Investigation · doi:10.1172/jci32409 · Cited by 951 · see citing works
Gutiérrez, O. M., Isakova, T., Rhee, E. P., Shah, A., Holmes, J., Collerone, G., Diaeresis]ppner, H. J., & Wolf, M. S. (2005) · Journal of the American Society of Nephrology · doi:10.1681/asn.2005010052 · Cited by 920 · see citing works
Relation Between Serum Phosphate Level and Cardiovascular Event Rate in People With Coronary Disease
Tonelli, M. A., Sacks, F. M., Pfeffer, M. A., Gao, Z., & Curhan, G. C. (2005) · Circulation · doi:10.1161/circulationaha.105.553198 · Cited by 883 · see citing works
Young, E. W., Albert, J. M., Satayathum, S. S., et al. (2005) · Kidney International · doi:10.1111/j.1523-1755.2005.00185.x · Cited by 756 · see citing works
Larsson, T., Nisbeth, U. L. F., Ljunggren, Ö., Jüppner, H., & Jonsson, K. B. (2003) · Kidney International · doi:10.1046/j.1523-1755.2003.00328.x · Cited by 689 · see citing works
Ferrari, S. L., Bonjour, J.-P., & Rizzoli, R. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1039 · Cited by 518 · see citing works
Krajisnik, T., Björklund, P., Marsell, R., Ljunggren, Ö., Åkerström, G., Jonsson, K. B., Westin, G., & Larsson, T. E. (2007) · Journal of Endocrinology · doi:10.1677/joe-07-0267 · Cited by 473 · see citing works
Regulation of C-Terminal and Intact FGF-23 by Dietary Phosphate in Men and Women
Burnett‐Bowie, S. M., Gunawardene, S. C., Bringhurst, F. R., Jüppner, H., Lee, H., & Finkelstein, J. S. (2006) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.060507 · Cited by 453 · see citing works
Portale, A. A., Booth, B. E., Halloran, B. P., et al. (1984) · Journal of Clinical Investigation · doi:10.1172/jci111365 · Cited by 357 · see citing works
Early Control of PTH and FGF23 in Normophosphatemic CKD Patients
de Oliveira, R. C., Cancela, A. L. E., Graciolli, F. G., dos Reis, L. M., Draibe, S. A., Cuppari, L., Carvalho, A. B., Jorgetti, V., Canziani, M. E. F., & Moysés, R. M. A. (2009) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.05420709 · Cited by 357 · see citing works
Effect of Food Additives on Hyperphosphatemia Among Patients With End-stage Renal Disease
Sullivan, C., Sayre, S. S., León, J. B., Machekano, R. N., Love, T. E., Porter, D., Marbury, M., & Sehgal, A. R. (2009) · JAMA · doi:10.1001/jama.2009.96 · Cited by 320 · see citing works
On the Pathogenesis of the Uremic State
Bricker, N. S. (1972) · New England Journal of Medicine · doi:10.1056/nejm197205182862009 · Cited by 318 · see citing works
Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease: An Overview
Bailie, G. R., & Massry, S. G. (2005) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.2005.25.12.1687 · Cited by 252 · see citing works
Acute effect of oral phosphate loading on serum fibroblast growth factor 23 levels in healthy men
Nishida, Y., Taketani, Y., Yamanaka-Okumura, H., Imamura, F., Taniguchi, A., Sato, T., Shuto, E., Nashiki, K., Arai, H., Yamamoto, H., et al. (2006) · Kidney International · doi:10.1038/sj.ki.5002000 · Cited by 243 · see citing works
Portale, A. A., Halloran, B. P., & Morris, R. C. (1987) · Journal of Clinical Investigation · doi:10.1172/jci113172 · Cited by 233 · see citing works
Medial arterial calcification and diabetic neuropathy.
EDMONDS, M. E., Morrison, N., Laws, J. W., et al. (1982) · BMJ · doi:10.1136/bmj.284.6320.928 · Cited by 213 · see citing works
FGF23 Fails to Inhibit Uremic Parathyroid Glands
Canalejo, R., Canalejo, A., Martinez-Moreno, J. M., Rodríguez-Ortiz, M. E., Estepa, J. C., Mendoza, F. J., Muñoz-Castañeda, J. R., Shalhoub, V., Almadén, Y., & Rodríguez, M. (2010) · Journal of the American Society of Nephrology · doi:10.1681/asn.2009040427 · Cited by 195 · see citing works
A rat model of chronic kidney disease-mineral bone disorder
Moe, S. M., Chen, N. X., Seifert, M. F., Sinders, R. M., Duan, D., Chen, X., Liang, Y., Radcliff, J. S., White, K. E., & Gattone, V. H. (2008) · Kidney International · doi:10.1038/ki.2008.456 · Cited by 163 · see citing works
Self-citationPostprandial Mineral Metabolism and Secondary Hyperparathyroidism in Early CKD
Isakova, T., Gutiérrez, O. M., Shah, A., et al. (2008) · Journal of the American Society of Nephrology · doi:10.1681/asn.2007060673 · Cited by 160 · see citing works
Teixeira, S. R., Tappenden, K. A., Carson, L., Erdman, J. W., Jones, R., Prabhudesai, M., & Marshall, W. P. (2004) · The Journal of Nutrition · doi:10.1093/jn/134.8.1874 · Cited by 157 · see citing works
Sherman, R. A., & Mehta, O. H. (2009) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2009.01.269 · Cited by 145 · see citing works
Nagano, N., Miyata, S., Abe, M., et al. (2006) · Kidney International · doi:10.1038/sj.ki.5000020 · Cited by 138 · see citing works
Azadbakht, L., & Esmaillzadeh, A. (2009) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2009.06.002 · Cited by 95 · see citing works
Worcester, E. M., Gillen, D. L., Evan, A. P., et al. (2007) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00115.2006 · Cited by 85 · see citing works
Narang, R., Ridout, D. A., Nonis, C., et al. (1997) · International Journal of Cardiology · doi:10.1016/s0167-5273(97)02971-9 · Cited by 82 · see citing works
Animal Versus Plant Protein Meals in Individuals With Type 2 Diabetes and Microalbuminuria
Wheeler, M. L., Fineberg, S. E., Fineberg, N. S., Gibson, R. G., & Hackward, L. L. (2002) · Diabetes Care · doi:10.2337/diacare.25.8.1277 · Cited by 71 · see citing works
Fibroblast growth factor 23 and the future of phosphorus management
Wolf, M. S. (2009) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0b013e328331a8c8 · Cited by 52 · see citing works
Albumin-corrected or ionized calcium in renal failure? What to measure?
Gøransson, L. G., Skadberg, Ø., & Bergrem, H. (2005) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfh988 · Cited by 51 · see citing works
Kyriazis, J., Stamatiadis, D. N., & Mamouna, A. (2000) · American Journal of Kidney Diseases · doi:10.1016/s0272-6386(00)70046-1 · Cited by 41 · see citing works
On the pathogenesis of the uremic state--an exposition of the trade-off hypothesis.
Bricker, N. S. (1974) · PubMed · Cited by 39 · see citing works
Shields, J. B., Fairbanks, B. W., Berryman, G. H., et al. (1940) · Journal of Nutrition · doi:10.1093/jn/20.3.263 · Cited by 20 · see citing works
Current Issues in the Management of Secondary Hyperparathyroidism and Bone Disease
Moe, S. M. (2001) · Peritoneal Dialysis International · doi:10.1177/089686080102103s43 · Cited by 16 · see citing works
Self-citationTrivedi, H., Moore, H. L., & Atalla, J. (2005) · Journal of Nephrology · doi:10.1093/joneph/18.4.417 · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [6]6. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group: KDIGO clinical practice guidelines for the management of CKD-MBD. Kidney Int Suppl 76: S1–S130, 2009 [DOI] [PubMed] [Google Scholar]
Cited by
Sorted by citations
KDOQI clinical practice guideline for nutrition in CKD: 2020 update
Ikizler, T. A., Burrowes, J. D., Byham-Gray, L. D., Campbell, K. L., Carrero, J.-J., Chan, W., Fouque, D., Friedman, A. N., Ghaddar, S., Goldstein-Fuchs, D. J., et al. (2020) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2020.05.006 · Cited by 1,960 · see citing works
Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function
Hertzler, S. R., Lieblein-Boff, J. C., Weiler, M., & Allgeier, C. (2020) · Nutrients · doi:10.3390/nu12123704 · Cited by 594 · see citing works
High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III
Chang, A. R., Lazo, M., Appel, L. J., Gutiérrez, O. M., & Grams, M. E. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.073148 · Cited by 262 · see citing works
The production of p-cresol sulfate and indoxyl sulfate in vegetarians versus omnivores
Patel, K. P., Luo, F. J.-G., Plummer, N. S., Hostetter, T. H., & Meyer, T. W. (2012) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.12491211 · Cited by 226 · see citing works
The associations of plant protein intake with all-cause mortality in CKD
Chen, X., Wei, G., Jalili, T., Metos, J., Giri, A., Cho, M. E., Boucher, R., Greene, T., & Beddhu, S. (2016) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2015.10.018 · Cited by 187 · see citing works
Kim, R. B., Morse, B. L., Djurdjev, O., Tang, M., Muirhead, N., Barrett, B., Holmes, D. T., Madore, F., Clase, C. M., Rigatto, C., et al. (2016) · Kidney International · doi:10.1016/j.kint.2016.01.014 · Cited by 179 · see citing works
Mediterranean diet as the diet of choice for patients with chronic kidney disease
Chauveau, P., Aparicio, M., Bellizzi, V., Campbell, K., Hong, X., Johansson, L., Kolko, A., Molina, P., Sezer, S., Wanner, C., et al. (2018) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfx085 · Cited by 165 · see citing works
Scialla, J. J., Appel, L. J., Wolf, M., Yang, W., Zhang, X., Sozio, S. M., Miller, E. R., Bazzano, L. A., Cuevas, M., Glenn, M. J., et al. (2012) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2012.01.026 · Cited by 115 · see citing works
Rhee, C. M., Wang, A. Y.-M., Biruete, A., Kistler, B., Kovesdy, C. P., Zarantonello, D., Ko, G. J., Piccoli, G. B., Garibotto, G., Brunori, G., et al. (2023) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2023.06.010 · Cited by 49 · see citing works
- Authors
- Moe, S. M., Zidehsarai, M. P., Chambers, M. A., Jackman, L. A., Radcliffe, J. S., Trevino, L. L., Donahue, S. E., & Asplin, J. R.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- Indiana University Indianapolis (US)
- Purdue University West Lafayette (US)
- Corresponding author
- Moe, Sharon M.
- Zidehsarai, Miriam P.
- Chambers, Mary A.
- Trevino, Laurie L.
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2011-02
- Volume
- 6
- Issue
- 2
- Pages
- 257-264
- ISSN
- 1555-9041 (ISSN-L)
- PMC
- PMC3052214
- OpenAlex
- W2100644178
- Cited by
- 564
- References
- 39
- Citations by year
- 2026: 22 · 2025: 27 · 2024: 21 · 2023: 31 · 2022: 40 · 2021: 65 · 2020: 53 · 2019: 28 · 2018: 33 · 2017: 47 · 2016: 45 · 2015: 40 · 2014: 25 · 2013: 48 · 2012: 29
- FWCI
- 21.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Indiana Clinical and Translational Sciences Institute
- Ministry of Earth Sciences
- Ministry of Education, India
- National Institute of Diabetes and Digestive and Kidney Diseases (DK002775, K24DK002775)
- National Center for Research Resources (UL RR025761, UL1RR025761)
- Topics
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- chronic kidney disease, phosphorus homeostasis, vegetarian diet, meat proteins, dietary protein source, phosphorus balance, fibroblast growth factor 23, parathyroid hormone, serum phosphorus, dietary phosphorus restriction
- MeSH terms
- Fibroblast Growth Factor-23, Aged, Calcium, Chronic Disease, Dietary Proteins, Female, Fibroblast Growth Factors, Glomerular Filtration Rate, Homeostasis, Humans, Indiana, Kidney Diseases, Male, Meat, Middle Aged, Parathyroid Hormone, Plant Proteins, Time Factors, Diet, Vegetarian, Biomarkers, Linear Models, Phosphorus, Dietary, Cross-Over Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
