Mediterranean Diet as the Diet of Choice for Patients With Chronic Kidney Disease

Philippe Chauveau; Michel Aparicio; Vincenzo Bellizzi; Katrina Campbell; Xu Hong; Lina Johansson; Anne Kolko; Pablo Molina; Siren Sezer; Christoph Wanner; Pieter M. ter Wee; Daniel Teta; Denis Fouque; Juan J. Carrero


Nephrol Dial Transplant. 2018;33(5):725-735. 

In This Article

Abstract and Introduction


Traditional dietary management of chronic kidney disease (CKD) focuses on the quantity within the diet of energy and protein, and the restriction of single micronutrients, with little mention of dietary quality. Dietary patterns that are more plant-based, lower in meat (including processed meat), sodium and refined sugar, and have a higher content of grains and fibres are now included in multiple clinical guidelines for chronic disease prevention. The Mediterranean diet (MD) has been associated with reduced cardiovascular disease incidence in both observational and interventional studies. A wealth of evidence links MD with other beneficial effects on chronic diseases such as diabetes, obesity or cognitive health. This review examines each constituent of the classical MD and evaluates their suitability for the management of patients with CKD. We also evaluate the potential hyperkalaemia risk of increasing fruit and vegetable intake. Overall, a decrease in net endogenous acid production and increase in fibre may lead to a better control of metabolic acidosis. This, together with other putative favourable effects of MD on endothelial function, inflammation, lipid profile and blood pressure, provide mechanistic pathways to explain the observed reduced renal function decline and improved survival in CKD patients adhering to an MD.


The potential role of a healthy diet is far more complex than delivering a combination of nutrients. Public health recommendations for prevention of cardiovascular disease (CVD) have, for instance, moved from a single-nutrient focus to whole foods and dietary patterns,[1] which are more easily translated into dietary recommendations. Patients with chronic kidney disease (CKD) are at high risk of CVD complications, contributing to the most common cause of death. Traditional dietary management of CKD focuses predominantly on the quantity within the diet of energy and protein, and the restriction of single micronutrients, with little mention of dietary quality. Emphasis on restriction of sodium, potassium and phosphorus in CKD may possibly compromise overall diet quality.[2]

Fruit and vegetable-rich diets such as the Mediterranean diet (MD) are recommended for primary and secondary disease prevention. Emerging evidence in patients with CKD suggests these diets may be helpful to delay progression and prevent complications.[3] Reluctance to recommend an MD to the CKD patient may arise when some of the typical components of the MD pyramid conflict with the traditional dietary restrictions of CKD. The European Renal Nutrition (ERN) Working Group of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA) aims, with this review, to summarize arguments in favour of and against adopting the MD as a healthy dietary pattern and lifestyle for the CKD population.