Traditional and Novel Dietary Interventions for Preventing Progression of Chronic Kidney Disease

Treatment of chronic kidney disease (CKD) and its complications remain largely unresolved. Currently used treatments include blood pressure control and the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), which can slow down the progression of CKD but are unable to halt or reverse it. Dietary protein restriction represents an additional therapeutic measure used to slow the progression of CKD. The putative mechanisms of action responsible for its therapeutic effects include beneficial hemodynamic effects and the limitation of absorbable protein breakdown products that could lead to the accumulation of uremic waste and consequent various deleterious effects. The practical implementation of protein restriction through dietary intervention has been hindered on multiple levels, including patient nonadherence, lack of health care resources, and concerns related to adverse effects associated with the development of protein-energy wasting (PEW). As a result, alternative interventions have been designed to address some or all of these shortcomings and concerns. One such intervention is the administration of medications that prevent the absorption of protein catabolic products from the gut. This article reviews the various interventions using such a strategy to prevent or slow the progression of CKD, with special focus on recent advances in this field.