Preservative Nutritional and Dietary Management of Chronic Kidney Disease Without Dialysis: Current Insights and Future Direction

Dear Colleagues,

Chronic kidney disease (CKD) is a significant global health issue, affecting around 11–13% of adults worldwide and over 25% of those aged 60 and older, likely with many cases still undiagnosed. We are all aware of the critical importance of nutritional and dietary management as a conservative and preservative kidney care measure to delay kidney disease progression, optimize health-related quality of life, stabilize metabolic health, and to reduce associated morbimortality risk, particularly in patients with CKD stages 3–5 not on dialysis.

Nutritional requirements vary across CKD stages, with dangerously restrictive modifications currently being applied to the diets of patients in stages 4–5, which are often unnecessarily extended to those in earlier stages. Conventionally and currently, nutritional therapy mainly focuses on the control/restriction of specific nutrients like protein and sodium intake, simultaneously limiting potassium and phosphorus intake. In recent years, this sometimes overly restrictive dietary approach has been increasingly questioned due to a lack of robust evidence in this setting. In addition, these guidelines present a challenge to reconcile, as people eat foods rather than isolated nutrients, and may inadvertently lead to a less healthy diet, thereby losing the beneficial effects of vitamins, minerals, and fiber associated with strict regimens, ultimately resulting in a worse prognosis for CKD in this group of patients. Contrary to the usual restrictive dietary practices, the most recent nutritional recommendations for kidney patients, the KDOQI-2020 guidelines, regardless of CKD stage, advocate for healthy dietary patterns as reno-protective measures, specifically, the Mediterranean diet and DASH—both predominantly plant-based—for their benefits on endothelial function, inflammation, lipid profile, blood pressure, and acid load. Despite their extensive pleiotropic benefits in CKD, resistance among physicians persists regarding the implementation of these diets in patients with CKD stages 3–5 without dialysis due to their content of fruits, vegetables, legumes, and nuts, which can contain significant amounts of potassium and phosphate, while randomized clinical trials in this setting are lacking. For instance, nuts are potentially renal health-promoting foods with a complex matrix of beneficial nutrients and bioactives and are key contributors to the nutritional quality of the diet; however, they have traditionally carried a negative connotation in Nephrology—likely unfounded—leading to their discouraged consumption in CKD patients. This necessitates more research on this topic. Also, mechanistically, the effects of bioactive nutrients/foods, dietary patterns, or nutritional strategies on inflammation, oxidative stress, endothelial dysfunction, and intestinal dysbiosis—conditions intrinsically linked to CKD and which play a pathophysiological role in promoting and exacerbating its progression and the development of comorbidities—remain areas of investigation in patients with overt CKD.

We are pleased to invite you and your colleagues to submit a feature paper (invited paper) to this Special Issue, which focuses on nutritional and dietary approaches as a major cornerstone in the conservative and preservative care of kidney disease in patients with CKD stages 3–5 without dialysis, encompassing perspectives ranging from specific nutrients, foods, or nutritional interventions to holistic approaches that consider dietary patterns and lifestyle. The specific objective of this Special Issue is to provide updated, evidence-based knowledge to deepen our understanding of this topic, with the ultimate aim of refining guidelines and advancing new nutritional strategies tailored to the needs of patients with chronic kidney disease. We encourage authors to submit their original research, regardless of whether the results are positive or negative, as both are essential for meaningful scientific progress.

We welcome the submission of a range of study designs, including randomized and non-randomized controlled trials, observational studies, systematic reviews, and meta-analyses.

We look forward to receiving your contributions.

Dr. Andrés Díaz-López
Guest Editor

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• nutrition
• dietary patterns
• bioactive nutrients
• nutritional intervention
• kidney function
• cardiovascular disease
• kidney disease
• cardio kidney disease
• inflammation
• oxidative stress
• endothelial dysfunction
• intestinal dysbiosis