High-Diversity Plant-Based Diets in CKD

The study by Stanford et al.1 contributes to an important issue for patients: reducing the rate of CKD progression. Patients struggle for years with CKD and its many effects, particularly the progressive decline in kidney function, which significantly affects their quality of life, one of the most crucial factors for them. Because CKD is an insidious disease, most patients experience the sensation that life is slowly slipping away from their bodies. This perception is undoubtedly one of the most challenging aspects to manage from a mental and emotional health perspective, in addition to its profound physical effect. A diet rich in fiber and high-diversity plant-based diet (HDPD) has emerged as a potential strategy for slowing CKD progression. However, most evaluations analyze surrogate end points that may guide new research, potentially opening new treatment perspectives and ultimately positively affecting patients' lives. A quick PubMed search using the terms “CKD” and “Diet” shows that publications on this topic have increased since 2004, reaching 402 in 2024. This trend supports the growing interest in the subject. However, when refining the search to include quality of life (i.e., “CKD” and “Diet” and “Quality of Life”), we find that in 2024, only 20 publications focused on this aspect. Although the study mentions quality of life measures, it does not provide a detailed description of this end point, which is one of the most critical factors for patients. There is no doubt that a diverse, fiber-rich diet is important. However, dietary habits are challenging to maintain in the long term, and it would be valuable to determine whether the benefits extend beyond 6 weeks, particularly concerning kidney function. Some end points, such as lower uremic toxins (Indoxyl) and p-Cresyl sulfate, were not consistently achieved. The gut microbiome varies significantly between populations and depends on dietary habits (e.g., Australian versus Latin American populations). In addition, considering different populations and locations, cost can be a determining factor. The study involved consuming 30 different plant-based foods per week, which may limit adherence in countries with low-income populations. Nonetheless, from the patients' perspective, we recognize that this study provides valuable preliminary evidence that increasing HDPD diet benefits patients with CKD. However, we urgently need answers. Although we understand that larger, longer, and more diverse studies are necessary to confirm whether the HDPD can slow CKD progression, for us, waiting means being tethered to a dialysis machine or remaining on an endless transplant waiting list.