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Cake day: November 3rd, 2024

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    There are multiple benefits of a vegan or vegetarian diet in the management of CKD: (1) Intake of animal fat is associated with albuminuria, and other components related to meat such as choline and carnitine are converted by gut flora into trimethylamine and trimethylamine N-oxide (TMAO) that are associated with atherosclerosis and renal fibrosis.10 (2) Vegan dieting leads to a decreased acid load, whereas ingestion of animal-based foods increases acidogenesis and ammonia production, and this favorable alkalization of vegan diet may have additional effects beyond what would be provided by mere intake of sodium bicarbonate.11 (3) There is less absorbable phosphorus in plant-based protein given the preponderance of indigestible phytate as the main source of phosphorus and given that fresh fruits or vegetables are less likely to have added phosphorus-based preservatives that are often used for meat processing.12,13 (4) Higher dietary fiber intake, in addition to a favorable modulation of advanced glycation end products,14 enhances gastrointestinal motility and lowers the likelihood of constipation, which is a likely contributor to hyperkalemia. (5) A vegan diet based on fresh fruits and vegetables lessen the likelihood of exposure to potassium-based additives.15,16 (6) There are potentially favorable impacts on the gut microbiome leading to lower generation of uremic toxins such as indoxyl sulfate, p-cresol sulfate, TMAO, and other unfavorable substances.17 TMAO is not only elevated as a consequence of renal insufficiency but also likely contributes to the progression of CKD and the risk of mortality in patients with CKD.18 There are other benefits from a higher intake of plant-based protein, such as lowering the likelihood of kidney stones and decreased risk of cardiovascular disease due to higher intake of natural antioxidants including carotenoids, tocopherols, and ascorbic acid.19