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s our awareness of chronic kidney disease (CKD) rolls over into a new era of bundling, improved treatment options, and medicinal choices, so our knowledge of nutrition and its impact on disease management also evolves. For decades, vegetarianism and kidney disease has been seen as an oil-andwater amalgamation. Dietitians have been challenged to align diet recommendations with vegetarian-type diets. Dietitians may struggle with concerns that more plantbased diets would be lacking in protein or would be high potassium and phosphorus. However, just as we have advanced in our understanding of so many aspects of kidney disease, we can now appreciate that a plant-based diet can work to our patient's advantage and, by learning these advantages, feel more comfortable with working these foods into patient meal planning.
Although studies are small, several support the idea that plant-based diets can delay the progression of CKD, provide endothelial protection, control high blood pressure, and decrease proteinuria. [1][2][3][4][5][6][7][8][9][10] These days, our dialysis patients seldom die secondary to high potassium or uremia. Many of our patients now face the same diseases as the general population: heart disease, cancer, and strokes. 11 A plantbased diet provides nutrients that not only assist in kidney disease management but also can provide an edge of protection against costly, debilitating complications. 8
Myths of a Plant-Based Diet
Poor-Quality Protein
It is now well documented that a plantbased diet can provide as high a quality protein diet as one that is animal based. In 1989 the International Food and Agriculture Organization (FAO), the World Health Organization (WHO), and the United Sates Department of Agriculture (USDA) adopted the Protein Digestibility-Corrected Amino Acid Score (PDCAAS) as the official assay for evaluation of protein quality. 12 The PDCAAS takes into account a protein's essential amino acid composition corrected for digestibility and referenced to a 2-to 5-year old human requirement. This new method of evaluating protein quality found that many plant proteins provide high-quality protein suitable to meet adult requirements.