Dietary Patterns for Obesity in CKD: Mediterranean, Low-Carbohydrate, and Plant-Forward Approaches-What Fits Best?

Obesity and chronic kidney disease (CKD) frequently coexist and mutually exacerbate metabolic, inflammatory, and hemodynamic disturbances that accelerate kidney function decline. Dietary therapy is central to weight management in CKD, yet traditional nutrient-restriction strategies may compromise diet quality and adherence. This review aims to evaluate the suitability of three major dietary patterns, the Mediterranean diet, plant-forward diets, and low-carbohydrate/ketogenic diets, for managing obesity in individuals with CKD.

A narrative review of current literature was conducted, synthesizing evidence from observational studies, randomized controlled trials, and clinical guidelines that examined the metabolic, cardiovascular, and renal effects of these dietary patterns in CKD patients with obesity.

Mediterranean and plant-dominant dietary patterns demonstrate consistent benefits in weight management, cardiovascular risk reduction, and kidney health. These diets are associated with improved insulin sensitivity, reduced dietary acid load, anti-inflammatory effects, and potential slowing of estimated glomerular filtration rate decline. Plant-forward diets may additionally improve gut microbiota composition and reduce uremic toxin generation. In contrast, low-carbohydrate and ketogenic diets can induce rapid short-term weight loss and glycemic improvements but raise concerns regarding metabolic acidosis, kidney stone risk, and uncertain long-term safety in CKD populations.

Current evidence suggests that Mediterranean and well-planned plant-forward dietary patterns are reasonable first-line options for many patients with obesity and CKD, given their favorable cardio-metabolic profiles and generally acceptable safety. However, the certainty of evidence for long-term kidney outcomes remains limited, and dietary recommendations should be individualized according to CKD stage, comorbidities, nutritional status, and patient preferences.