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Safety and impact of the Mediterranean diet in patients with chronic kidney disease: a pilot randomized crossover
Yu-Jin Kwon1, Young Su Joo2, Hae-Ryong Yun2
1Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
Introduction:
Emerging evidence highlights the potential advantages of the Mediterranean diet (MD) in preserving kidney function and slowing chronic kidney disease (CKD) progression. However, interventional studies on the MD are scarce in East Asian populations.
Methods:
This randomized crossover trial aimed to assess the safety and short-term impact of the Mediterranean Proper Optimal Balance (MEDi-POB) diet in Korean patients with stage 3-4 CKD. Kidney function was assessed using the estimated glomerular filtration rate, which was calculated using the CKD Epidemiology Collaboration equation. Fifty patients with CKD were randomly assigned to two groups, each starting with a different 4-week intervention, followed by a 4-week washout period, followed by a switch to the other 4-week intervention. During the MEDi-POB intervention, patients received home delivery of meals twice daily, 5 days a week, while the control intervention comprised a conventional diet. Forty-six patients successfully completed the entire 12-week trial. Paired t-tests were conducted to assess mean differences between the two groups. A linear mixed model was used to adjust for sequence and period.
Results:
Dietary fat, fiber, and niacin intake were significantly higher following the MEDi-POB diet than following the control diet (p = 0.001 for fat, p < 0.001 for fiber, and p = 0.007 for niacin). The MEDi-POB diet also yielded slightly increased total CO2 levels (p = 0.043), indicating effective management of metabolic acidosis. Conversely, sodium and copper intake were significantly lower with the MEDi-POB diet (p = 0.032 and p = 0.037, respectively). Caloric intake increased, but body mass index slightly decreased from baseline after consuming the MEDi-POB diet. Dietary potassium intake exhibited a non-significant increase (p = 0.053), and no significant changes in serum (p = 0.883) and urine potassium levels (p = 0.087) occurred. Kidney function remained well-preserved following the MEDi-POB diet.
Conclusion:
These results indicate that the MEDi-POB diet is safe even in patients with advanced CKD, as it does not adversely affect serum and urine potassium levels and helps maintain kidney function.
Insights
The Mediterranean Proper Optimal Balance (MEDi-POB) diet is safe for Korean patients with chronic kidney disease (CKD). This diet helps maintain kidney function and manage metabolic acidosis without negatively impacting potassium levels.
Area of Science:
- Nephrology
- Nutritional Science
- Clinical Nutrition
Background:
- The Mediterranean diet (MD) shows promise in preserving kidney function and slowing chronic kidney disease (CKD) progression.
- Interventional studies on the MD are limited in East Asian populations, necessitating research in this demographic.
Purpose of the Study:
- To evaluate the safety and short-term effects of the Mediterranean Proper Optimal Balance (MEDi-POB) diet.
- To assess the impact of the MEDi-POB diet on kidney function in Korean patients with stage 3-4 CKD.
Main Methods:
- A randomized crossover trial involving 50 Korean patients with stage 3-4 CKD.
- Participants underwent two 4-week intervention periods: MEDi-POB diet with home-delivered meals or a conventional control diet, separated by a 4-week washout period.
- Kidney function was assessed via estimated glomerular filtration rate (eGFR); dietary intake and metabolic markers were also analyzed.
Main Results:
- The MEDi-POB diet significantly increased intake of fat, fiber, and niacin, while decreasing sodium and copper intake.
- Patients on the MEDi-POB diet showed improved management of metabolic acidosis (increased CO2 levels) and a slight decrease in body mass index.
- Kidney function (eGFR) was well-preserved, and serum and urine potassium levels remained stable, indicating safety.
Conclusions:
- The MEDi-POB diet is safe for Korean patients with advanced CKD (stage 3-4).
- This dietary intervention effectively maintains kidney function and aids in managing metabolic acidosis.
- The MEDi-POB diet does not adversely affect potassium homeostasis in CKD patients.
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