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Nutrients
Volume 17
Issue 12
10.3390/nu17122002
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Review

Dos and Don’ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease

by
Massimo Torreggiani
1,*,
Carla Maria Avesani
2,
Barbara Contzen
3,
Adamasco Cupisti
4,
Sylwia Czaja-Stolc
5,
Claudia D’Alessandro
4,
Liliana Garneata
6,
Abril Gutiérrez
7,
Françoise Lippi
1,
Carmen Antonia Mocanu
6,
Alice Sabatino
2 and
Giorgina Barbara Piccoli
1 the European Renal Nutrition (ERN) Working Group of the European Renal Association
1
Néphrologie et dialyse, Centre Hospitalier Le Mans, 72037 Le Mans, France
2
Division of Renal Medicine, Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, 14186 Stockholm, Sweden
3
NephroLogik—Ernährungstherapie bei chronischer Niereninsuffizienz, 51465 Bergisch Gladbach, Germany
4
Division of Nephrology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
5
Department of Clinical Nutrition and Dietetics, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland
6
Department of Internal Medicine and Nephrology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
7
Sociedad Mexicana de Etudios en Ciencias de la Salud, Mexico City 06760, Mexico
*
Author to whom correspondence should be addressed.
Nutrients 2025, 17(12), 2002; https://doi.org/10.3390/nu17122002 (registering DOI)
Submission received: 1 April 2025 / Revised: 11 June 2025 / Accepted: 12 June 2025 / Published: 14 June 2025
(This article belongs to the Special Issue Reducing the Burden of Chronic Diseases Through Plant-Based Diets)
Versions Notes

Abstract

Dietary management is a pillar of chronic kidney disease (CKD) treatment. While some rules are the same as dietary prescriptions for the general population and those suffering from other chronic diseases (energy intake, salt intake, avoidance of ultra-processed food and limited intake of animal fats), in non-dialysis-dependent patients living with CKD, the specific focus is on protein intake. Low-protein diets (LPDs) and supplemented very low protein diets (sVLPDs) have been successfully employed to decrease the symptoms of people living with non-dialysis-dependent CKD, delay the progression of the disease and retard the need for dialysis. Randomized clinical trials have yielded conflicting results on efficacy, resulting in conflicting guidelines. Concerns about the risk of malnutrition (specifically when the main source of proteins is plant-derived), electrolyte imbalances, and energy intake, and the idea that adherence is difficult, jeopardize the use and wide application of LPDs and sVLPDs. That dietary management focuses mainly on nutrients while dietary quality occupies second place is also an erroneous concept that requires discussion. In September 2023, a group of experts composed of nephrologists and dieticians gathered in Frankfurt, Germany, to try to reconcile the different guideline indications and address most of the common doubts of final dispatchers to increase the prescription of “renal diets” and improve people living with CKD’s adherence to them.
Keywords: low-protein diets; protein intake; elderly patients; ketoanalogues; ultra-processed food; education low-protein diets; protein intake; elderly patients; ketoanalogues; ultra-processed food; education

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MDPI and ACS Style

Torreggiani, M.; Avesani, C.M.; Contzen, B.; Cupisti, A.; Czaja-Stolc, S.; D’Alessandro, C.; Garneata, L.; Gutiérrez, A.; Lippi, F.; Mocanu, C.A.; et al. Dos and Don’ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease. Nutrients 2025, 17, 2002. https://doi.org/10.3390/nu17122002

AMA Style

Torreggiani M, Avesani CM, Contzen B, Cupisti A, Czaja-Stolc S, D’Alessandro C, Garneata L, Gutiérrez A, Lippi F, Mocanu CA, et al. Dos and Don’ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease. Nutrients. 2025; 17(12):2002. https://doi.org/10.3390/nu17122002

Chicago/Turabian Style

Torreggiani, Massimo, Carla Maria Avesani, Barbara Contzen, Adamasco Cupisti, Sylwia Czaja-Stolc, Claudia D’Alessandro, Liliana Garneata, Abril Gutiérrez, Françoise Lippi, Carmen Antonia Mocanu, and et al. 2025. "Dos and Don’ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease" Nutrients 17, no. 12: 2002. https://doi.org/10.3390/nu17122002

APA Style

Torreggiani, M., Avesani, C. M., Contzen, B., Cupisti, A., Czaja-Stolc, S., D’Alessandro, C., Garneata, L., Gutiérrez, A., Lippi, F., Mocanu, C. A., Sabatino, A., & Barbara Piccoli, G., the European Renal Nutrition (ERN) Working Group of the European Renal Association. (2025). Dos and Don’ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease. Nutrients, 17(12), 2002. https://doi.org/10.3390/nu17122002

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