THERAPEUTIC APPROACH IN THE MANAGEMENT OF PERITONEAL DIALYSIS; PLANT-BASED DIET AND ASSOCIATED PARAMETERS, A COMPREHENSIVE REVIEW
Main Article Content
Keywords
Chronic Kidney Disease (CKD), Diet and Dialysis, Kidney Disease, Metabolic Parameters, Plant-Based Diet, Renal Nutrition, Therapeutic Approach
Abstract
Peritoneal dialysis (PD) has remained a cornerstone in renal replacement therapy since 1794, leveraging the peritoneal membrane to effectively filter toxins and excess fluid. Offering patients flexibility and autonomy, PD allows for treatment at home or amidst daily routines. However, persistent challenges such as PD-related infections and catheter insertion obstacles necessitate ongoing strategies like biocompatible solutions and improved catheter designs to mitigate risks. Concurrently, patient education and telemedicine play pivotal roles in enhancing PD management.
In recent years, the surge in veganism, a lifestyle advocating for the elimination of animal exploitation, has been notable. Vegan diets, characterized by plant-based foods and the exclusion of animal products, hold promise for various health benefits, particularly in chronic kidney disease (CKD) management. While studies suggest potential advantages such as delaying the need for dialysis and improving cardiovascular health in CKD patients, the impact of vegan diets on end-stage kidney disease (ESKD) patients undergoing PD remains uncertain.
PD patients encounter diverse challenges, including volume overload and constipation, which can be addressed through dietary modifications such as sodium restriction and increased fiber intake. Vegan diets, typically low in sodium and rich in fiber, may offer advantages in managing these complications. Additionally, they have been associated with benefits like weight loss, improved gut health, and reduced inflammation, which could potentially benefit PD patients.
However, concerns regarding nutrient deficiencies, particularly in vitamin D and vitamin B12, highlight the need for careful monitoring and supplementation in vegan diets. Further investigation is warranted to assess the suitability of vegan diets for PD patients comprehensively. Nutrition education and counseling are crucial for optimizing dietary choices and enhancing outcomes in PD patients. Understanding the intricate relationship between vegan diets and PD outcomes is imperative for delivering holistic care to this patient population.
References
2. Barsotti, G., Morelli, E., Cupisti, A., Meola, M., Dani, L., & Giovannetti, S. (1996). A low-nitrogen low-phosphorus Vegan diet for patients with chronic renal failure. Nephron, 74(2), 390–394.
3. Blumenkrantz, M. J., Gahl, G. M., Kopple, J. D., Kamdar, A. V, Jones, M. R., Kessel, M., & Coburn, J. W. (1981). Protein losses during peritoneal dialysis. Kidney International, 19(4), 593–602.
4. Carrero, J. J., González-Ortiz, A., Avesani, C. M., Bakker, S. J. L., Bellizzi, V., Chauveau, P., Clase, C. M., Cupisti, A., Espinosa-Cuevas, A., Molina, P., Moreau, K., Piccoli, G. B., Post, A., Sezer, S., & Fouque, D. (2020). Plant-based diets to manage the risks and complications of chronic kidney disease. Nature Reviews Nephrology, 16(9), 525–542. https://doi.org/10.1038/s41581-020-0297-2
5. Carrero, J. J., Thomas, F., Nagy, K., Arogundade, F., Avesani, C. M., Chan, M., Chmielewski, M., Cordeiro, A. C., Espinosa-Cuevas, A., & Fiaccadori, E. (2018). Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism. Journal of Renal Nutrition, 28(6), 380–392.
6. Crowe, F. L., Steur, M., Allen, N. E., Appleby, P. N., Travis, R. C., & Key, T. J. (2011). Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC–Oxford study. Public Health Nutrition, 14(2), 340–346.
7. Cullis, B., Al-Hwiesh, A., Kilonzo, K., McCulloch, M., Niang, A., Nourse, P., Parapiboon, W., Ponce, D., & Finkelstein, F. O. (2021). ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults). Peritoneal Dialysis International, 41(1), 15–31. https://doi.org/10.1177/0896860820970834
8. Davies, S. J. (2013). Peritoneal dialysis—current status and future challenges. Nature Reviews Nephrology, 9(7), 399–408.
9. Duong, T. Van, Tsao, C.-A., Yang, E., Peng, C.-H., Hou, Y.-C., Su, Y.-C., Chang, J.-T., & Yang, S.-H. (2019). Education and protein supplementation improve nutritional biomarkers among hypoalbuminemic peritoneal dialysis patients: a quasi-experimental design. Healthcare, 7(4), 135.
10. Dupuis, L., Brown-Tortorici, A., Kalantar-Zadeh, K., & Joshi, S. (2021). A Mini Review of Plant-Based Diets in Hemodialysis. Blood Purification, 50(4–5), 672–677. https://doi.org/10.1159/000516249
11. Gibbs, J., & Cappuccio, F. P. (2024). Common Nutritional Shortcomings in Vegetarians and Vegans. 114–128.
12. Hsu, H. J., Yen, C. H., Wu, I. W., Liu, M. H., Cheng, H. Y., Lin, Y. T., Lee, C. C., Hsu, K. H., Sun, C. Y., Chen, C. Y., & Wang, C. H. (2021). The association between low protein diet and body composition, muscle function, inflammation, and amino acid-based metabolic profile in chronic kidney disease stage 3–5 patients. Clinical Nutrition ESPEN, 46, 405–415. https://doi.org/10.1016/j.clnesp.2021.08.037
13. Imani, H., Tabibi, H., Atabak, S., Rahmani, L., Ahmadinejad, M., & Hedayati, M. (2009). Effects of soy consumption on oxidative stress, blood homocysteine, coagulation factors, and phosphorus in peritoneal dialysis patients. Journal of Renal Nutrition, 19(5), 389–395.
14. Jolly, S., Chatatalsingh, C., Bargman, J., Vas, S., Chu, M., & Oreopoulos, D. G. (2001). Excessive weight gain during peritoneal dialysis. The International Journal of Artificial Organs, 24(4), 197–202.
15. Koeder, C., & Perez-Cueto, F. J. A. (2024). Vegan nutrition: a preliminary guide for health professionals. Critical Reviews in Food Science and Nutrition, 64(3), 670–707. https://doi.org/10.1080/10408398.2022.2107997
16. Kristensen, N. B., Madsen, M. L., Hansen, T. H., Allin, K. H., Hoppe, C., Fagt, S., Lausten, M. S., Gøbel, R. J., Vestergaard, H., & Hansen, T. (2015). Intake of macro-and micronutrients in Danish vegans. Nutrition Journal, 14, 1–10.
17. Liebman, S. E., & Joshi, S. (2022). Plant-Based Diets and Peritoneal Dialysis: A Review. Nutrients, 14(6), 1304.
18. Lindner, G., Burdmann, E. A., Clase, C. M., Hemmelgarn, B. R., Herzog, C. A., Malyszko, J., Nagahama, M., Pecoits-Filho, R., Rafique, Z., & Rossignol, P. (2020). Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. European Journal of Emergency Medicine, 27(5), 329–337.
19. Liu, H. W., Tsai, W. H., Liu, J. S., & Kuo, K. L. (2019). Association of vegetarian diet with chronic kidney disease. Nutrients, 11(2), 1–8. https://doi.org/10.3390/nu11020279
20. Lombardo, M., Aulisa, G., Marcon, D., & Rizzo, G. (2022). The influence of animal-or plant-based diets on blood and urine trimethylamine-N-oxide (TMAO) levels in humans. Current Nutrition Reports, 11(1), 56–68.
21. Mariotti, F., & Gardner, C. D. (2019). Dietary protein and amino acids in vegetarian diets—A review. Nutrients, 11(11), 2661.
22. Marrone, G., Guerriero, C., Palazzetti, D., Lido, P., Marolla, A., Di Daniele, F., & Noce, A. (2021). Vegan diet health benefits in metabolic syndrome. Nutrients, 13(3), 817.
23. Najjar, R. S., & Feresin, R. G. (2019). Plant-based diets in the reduction of body fat: physiological effects and biochemical insights. Nutrients, 11(11), 2712.
24. Navaratnarajah, A., Clemenger, M., McGrory, J., Hisole, N., Chelapurath, T., Corbett, R. W., & Brown, E. A. (2021). Flexibility in peritoneal dialysis prescription: Impact on technique survival. Peritoneal Dialysis International, 41(1), 49–56.
25. Ramos, C. I., Nerbass, F. B., & Cuppari, L. (2022). Constipation in chronic kidney disease: it is time to Bridge the Gap. Kidney and Dialysis, 2(2), 221–233.
26. Regunath, H., Ludwig, K., & Khanna, R. (2023). Peritoneal Infections in Peritoneal Dialysis (PD Peritonitis). In Nolph and Gokal’s Textbook of Peritoneal Dialysis (pp. 431–465). Springer.
27. Rippe, B., & Öberg, C. M. (2016). Albumin turnover in peritoneal and hemodialysis. Seminars in Dialysis, 29(6), 458–462.
28. Roeder, T. (2021). Beyond diet: Veganism as liberatory praxis. Veg (Etari) an Arguments in Culture, History, and Practice: The V Word, 291–318.
29. Rosenfeld, D. L. (2018). The psychology of vegetarianism: Recent advances and future directions. Appetite, 131, 125–138.
30. Shah, N., Bernardini, J., & Piraino, B. (2005). Prevalence and correction of 25 (OH) vitamin D deficiency in peritoneal dialysis patients. Peritoneal Dialysis International, 25(4), 362–366.
31. Silva Souza, L. G., Atkinson, A., & Montague, B. (2020). Perceptions about veganism.
32. St-Jules, D. E., & Fouque, D. (2024). Response to “Plant-based diets and postprandial hyperkalemia.” Nutrition Reviews, 82(4), 572–577.
33. Świątek, Ł., Jeske, J., Miedziaszczyk, M., & Idasiak-Piechocka, I. (2023). The impact of a vegetarian diet on chronic kidney disease (CKD) progression – a systematic review. BMC Nephrology, 24(1), 1–8. https://doi.org/10.1186/s12882-023-03233-y
34. Van Biesen, W., Verger, C., Heaf, J., Vrtovsnik, F., Britto, Z. M. L., Do, J.-Y., Prieto-Velasco, M., Martínez, J. P., Crepaldi, C., & De los Ríos, T. (2019). Evolution over time of volume status and PD-related practice patterns in an incident peritoneal dialysis cohort. Clinical Journal of the American Society of Nephrology, 14(6), 882–893.
35. Verzola, D., Picciotto, D., Saio, M., Aimasso, F., Bruzzone, F., Sukkar, S. G., Massarino, F., Esposito, P., Viazzi, F., & Garibotto, G. (2020). Low protein diets and plant-based low protein diets: do they meet protein requirements of patients with chronic kidney disease? Nutrients, 13(1), 83.
36. Viswanathan, V., Snehalatha, C., Varadharani, M. P., Nair, B. M., Jayaraman, M., & Ramachandran, A. (2002). Prevalence of albuminuria among vegetarian and non-vegetarian south Indian diabetic patients. Indian Journal of Nephrology, 12(3), 73–76.
37. Volhard, F. (2019). Die doppelseitigen hämatogenen Nierenerkrankungen (Brightsche Krankheit). Springer-Verlag.
38. Wheeler, D. C., & Winkelmayer, W. C. (2017). KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) foreword. Kidney International Supplements, 7(1), 1–59.
39. Wrenn, C. (2022). Society Writings.
40. Xu, X., Li, Z., Chen, Y., Liu, X., & Dong, J. (2019). Dietary fibre and mortality risk in patients on peritoneal dialysis. British Journal of Nutrition, 122(9), 996–1005.
41. Yin, L., Dong, X., Liao, W., Liu, X., Zheng, Z., Liu, D., Wang, C., & Liu, Z. (2023). Relationships of beans intake with chronic kidney disease in rural adults: A large-scale cross-sectional study. Frontiers in Nutrition, 10(April), 1–10. https://doi.org/10.3389/fnut.2023.1117517
42. Zarantonello, D., & Brunori, G. (2023). The Role of Plant-Based Diets in Preventing and Mitigating Chronic Kidney Disease: More Light than Shadows. Journal of Clinical Medicine, 12(19). https://doi.org/10.3390/jcm12196137
43. Zeiler, M., & Granata, A. (2021). Peritoneal Dialysis Catheter. In Imaging in Nephrology (pp. 251–267). Springer.
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Bareera Sana
Student, University Institute of Diet & Nutritional Sciences, The University of Lahore, Pakistan
Ammar Masood
Research Scholar, Department of Nutritional Sciences, Faculty of Life Sciences, Government College University Faisalabad, Pakistan
Laraib Akram
Clinical Nutritionist at Diet by Design, Lahore, Pakistan
Areej Saleem
Lecturer, Khawaja Fareed University of Engineering and Information Technology (KFUIET)
Afaf Tahir
Consultant Dietitian, Al-Noor Hospital Sheikhupura, Oladoc, Pakistan
Sara Mazhar
Clinical Dietitian and Nutritionist, Asaaf Medical Complex Lahore, Pakistan
Khadija Bukhari
MPhil/Research Scholar, Superior University, Lahore, Pakistan
Anam Zubair
Lecturer, Nur International University, Lahore, Pakistan
Wajeeha Arooj
MPhil Scholar, University Institute of Diet & Nutritional Sciences, The University of Lahore, Pakistan