{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T19:35:11Z","timestamp":1785267311832,"version":"3.55.0"},"reference-count":78,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EU NextGenerationEU through the Recovery and Resilience Plan for Slovakia","award":["09I03-03-V04-00211"],"award-info":[{"award-number":["09I03-03-V04-00211"]}]},{"DOI":"10.13039\/501100005357","name":"Slovak Research and Development Agency","doi-asserted-by":"crossref","award":["VV-MVP-24-0252"],"award-info":[{"award-number":["VV-MVP-24-0252"]}],"id":[{"id":"10.13039\/501100005357","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Protein\u2013energy wasting (PEW) is a major predictor of morbidity and mortality in patients with chronic kidney disease (CKD), even before the initiation of dialysis. Its multifactorial pathogenesis includes reduced dietary intake, chronic inflammation, metabolic acidosis, hormonal disturbances, and dysbiosis of the gut microbiota. Early recognition and targeted management are crucial for preventing muscle loss, functional decline, and adverse outcomes. Methods: This narrative review summarises and integrates current evidence from the literature on nutritional and metabolic interventions to prevent and treat protein\u2013energy wasting in patients with nondialysis chronic kidney disease. Relevant clinical trials, meta-analyses, and experimental studies published up to date were evaluated, focusing on dietary strategies, metabolic modulation, physical exercise, and gut microbiome-targeted therapies. Results: Adequate energy and protein intake remain the cornerstone of PEW management, based on available clinical and observational evidence. Individualised diets emphasising high-quality and plant-based proteins, oral nutritional supplements, and ketoanalogues can attenuate muscle wasting. Correction of metabolic acidosis and inflammation enhances protein anabolism and nitrogen balance. Physical exercise acts synergistically with dietary interventions to preserve muscle mass and function. Novel approaches\u2014such as modulating the gut\u2013kidney axis with pre-, pro-, and postbiotics or supplementing with short-chain fatty acids\u2014show promise in improving metabolic and inflammatory profiles. Conclusions: The management of PEW in nondialysis CKD requires a personalised approach that integrates nutrition, physical activity, metabolic correction and microbiome modulation. Early, coordinated intervention may help to slow the progression of CKD and improve patient survival and quality of life.<\/jats:p>","DOI":"10.3390\/nu18030390","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T11:14:07Z","timestamp":1769426047000},"page":"390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Nutritional and Metabolic Interventions to Prevent and Treat Protein\u2013Energy Wasting in Nondialysis CKD\u2014Narrative Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5156-5226","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Kleinov\u00e1","sequence":"first","affiliation":[{"name":"Transplant-Nehrology Department, University Hospital Martin, Koll\u00e1rova 2, 036 01 Martin, Slovakia"},{"name":"Department of Internal Medicine I, Jessenius Medical Faculty, Comenius University, 036 01 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3303-2164","authenticated-orcid":false,"given":"Blichov\u00e1","family":"T\u00edmea","sequence":"additional","affiliation":[{"name":"Transplant-Nehrology Department, University Hospital Martin, Koll\u00e1rova 2, 036 01 Martin, Slovakia"},{"name":"Department of Internal Medicine I, Jessenius Medical Faculty, Comenius University, 036 01 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1761-1425","authenticated-orcid":false,"given":"Vnu\u010d\u00e1k","family":"Matej","sequence":"additional","affiliation":[{"name":"Transplant-Nehrology Department, University Hospital Martin, Koll\u00e1rova 2, 036 01 Martin, Slovakia"},{"name":"Department of Internal Medicine I, Jessenius Medical Faculty, Comenius University, 036 01 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8834-0365","authenticated-orcid":false,"given":"Karol","family":"Gra\u0148\u00e1k","sequence":"additional","affiliation":[{"name":"Transplant-Nehrology Department, University Hospital Martin, Koll\u00e1rova 2, 036 01 Martin, Slovakia"},{"name":"Department of Internal Medicine I, Jessenius Medical Faculty, Comenius University, 036 01 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7859-3183","authenticated-orcid":false,"given":"Koll\u00e1r","family":"Andrej","sequence":"additional","affiliation":[{"name":"Transplant-Nehrology Department, University Hospital Martin, Koll\u00e1rova 2, 036 01 Martin, Slovakia"},{"name":"Department of Internal Medicine I, Jessenius Medical Faculty, Comenius University, 036 01 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0160ev\u010d\u00edkov\u00e1","family":"Katar\u00edna","sequence":"additional","affiliation":[{"name":"Transplant-Nehrology Department, University Hospital Martin, Koll\u00e1rova 2, 036 01 Martin, Slovakia"},{"name":"Department of Internal Medicine I, Jessenius Medical Faculty, Comenius University, 036 01 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8246-4268","authenticated-orcid":false,"given":"Ivana","family":"Dedinsk\u00e1","sequence":"additional","affiliation":[{"name":"Transplant-Nehrology Department, University Hospital Martin, Koll\u00e1rova 2, 036 01 Martin, Slovakia"},{"name":"Department of Internal Medicine I, Jessenius Medical Faculty, Comenius University, 036 01 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1002\/jcsm.12421","article-title":"Kidney cachexia or protein-energy wasting in chronic kidney disease: Facts and numbers","volume":"10","author":"Koppe","year":"2019","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1053\/j.ajkd.2021.10.012","article-title":"A Novel Approach for Managing Protein-Energy Wasting in People with Kidney Failure Undergoing Maintenance Hemodialysis: Rationale and Call for Trials","volume":"80","author":"Fouque","year":"2022","journal-title":"Am. J. Kidney Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/jorc.12378","article-title":"Protein energy wasting and long-term outcomes in nondialysis-dependent chronic kidney disease","volume":"48","author":"Franco","year":"2022","journal-title":"J. Ren. Care"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Roth-Stefanski, C.T., de Almeida, N.R., Biagini, G., Scatone, N.K., Nerbass, F.B., and de Moraes, T.P. (2021). The diagnosis of protein-energy wasting in chronic peritoneal dialysis patients is influenced by the method of calculating muscle mass: A prospective, multicenter study. Front. Med., 8.","DOI":"10.3389\/fmed.2021.702749"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/sj.ki.5002585","article-title":"A proposed nomenclature and diagnostic criteria for protein\u2013energy wasting in acute and chronic kidney disease","volume":"73","author":"Fouque","year":"2008","journal-title":"Kidney Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1053\/j.jrn.2014.06.008","article-title":"A simple protein-energy wasting score predicts survival in maintenance hemodialysis patients","volume":"24","author":"Jean","year":"2014","journal-title":"J. Ren. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chen, S., Ma, X., Zhou, X., Wang, Y., Liang, W., Zheng, L., Zang, X., Mei, X., Qi, Y., and Jiang, Y. (2022). An updated clinical prediction model of protein-energy wasting for hemodialysis patients. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.933745"},{"key":"ref_8","unstructured":"(2025, October 21). Frontiers in Nutrition. Available online: https:\/\/www.frontiersin.org\/journals\/nutrition\/articles\/10.3389\/fnut.2024.1351503\/full."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zha, Y., and Qian, Q. (2017). Protein nutrition and malnutrition in CKD and ESRD. Nutrients, 9.","DOI":"10.3390\/nu9030208"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Saadat, Y.R., Abbasi, A., Hejazian, S.S., Hekmatshoar, Y., Ardalan, M., Farnood, F., and Vahed, S.Z. (2025). Combating chronic kidney disease-associated cachexia: A literature review of recent therapeutic approaches. BMC Nephrol., 26.","DOI":"10.1186\/s12882-025-04057-8"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1186\/s12964-024-01922-1","article-title":"The gut microbiome, chronic kidney disease, and sarcopenia","volume":"22","author":"Zheng","year":"2024","journal-title":"Cell Commun. Signal."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kadatane, S.P., Satariano, M., Massey, M., Mongan, K., and Raina, R. (2023). The role of inflammation in CKD. Cells, 12.","DOI":"10.3390\/cells12121581"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Heitman, K., Alexander, M.S., and Faul, C. (2024). Skeletal muscle injury in chronic kidney disease\u2014From histologic changes to molecular mechanisms and to novel therapies. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25105117"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2147\/CIA.S516704","article-title":"Molecular and cellular mechanisms linking chronic kidney disease and sarcopenia in aging: An integrated perspective","volume":"20","author":"Chang","year":"2025","journal-title":"Clin. Interv. Aging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/1743-7075-9-36","article-title":"Exploring metabolic dysfunction in chronic kidney disease","volume":"9","author":"Slee","year":"2012","journal-title":"Nutr. Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/j.1744-9987.2010.00818.x","article-title":"Association between body mass and mortality in maintenance hemodialysis patients","volume":"14","author":"Yen","year":"2010","journal-title":"Ther. Apher. Dial."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Shirsat, P., Balachandran, M., Chamarthi, V.S., and Sonavane, K. (2025). Obesity and Chronic Kidney Disease: A Comprehensive Review of Mechanisms, Impact, and Management Strategies. J. CardioRenal Med., 1.","DOI":"10.3390\/jcrm1010004"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.kint.2017.08.025","article-title":"Body composition is associated with clinical outcomes in patients with non\u2013dialysis-dependent chronic kidney disease","volume":"93","author":"Lin","year":"2018","journal-title":"Kidney Int."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"(2024). Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"257","DOI":"10.2215\/CJN.05040610","article-title":"Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease","volume":"6","author":"Moe","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_21","unstructured":"ESPEN (2025, December 08). ESPEN Practical Guidelines\u2014Web Version. ESPEN Web App. Available online: https:\/\/guidelines.espen.org\/espen-web-app\/gl_toc\/index.php?GL_id=13&loadInteractiveTool=1."},{"key":"ref_22","first-page":"Doc11","article-title":"Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine. Parenteral nutrition in patients with renal failure\u2014Guidelines on parenteral nutrition, chapter 17","volume":"7","author":"Druml","year":"2009","journal-title":"Ger. Med. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/joim.20117","article-title":"Low-protein diet for chronic kidney disease: Evidence, controversies, and practical guidelines","volume":"298","author":"Mafra","year":"2025","journal-title":"J. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1093\/ckj\/sfad130","article-title":"Effects of oral nutritional supplements on the nutritional status and inflammatory markers in patients on maintenance dialysis: A systematic review and meta-analysis of randomized clinical trials","volume":"16","author":"Liu","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1177\/0148607113517266","article-title":"Long-term oral nutrition supplementation improves outcomes in malnourished patients with chronic kidney disease on hemodialysis","volume":"38","author":"Sezer","year":"2014","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1915138","DOI":"10.1001\/jamanetworkopen.2019.15138","article-title":"Association of Nutritional Support with Clinical Outcomes Among Medical Inpatients Who Are Malnourished or at Nutritional Risk: An Updated Systematic Review and Meta-analysis","volume":"2","author":"Gomes","year":"2019","journal-title":"JAMA Netw. Open."},{"key":"ref_27","first-page":"CD012616","article-title":"Oral protein-based supplements versus placebo or no treatment for people with chronic kidney disease requiring dialysis","volume":"5","author":"Mah","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1681\/ASN.2012070732","article-title":"Impact of early parenteral nutrition on metabolism and kidney injury","volume":"24","author":"Gunst","year":"2013","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s13054-016-1298-1","article-title":"Enteral versus parenteral nutrition in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials","volume":"20","author":"Elke","year":"2016","journal-title":"Cri. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1743-7075-9-40","article-title":"Nutritional regulation of muscle protein synthesis with resistance exercise: Strategies to enhance anabolism","volume":"9","author":"Burd","year":"2012","journal-title":"Nutr. Metab."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12986-016-0124-8","article-title":"The impact of protein quality on the promotion of resistance exercise-induced changes in muscle mass","volume":"13","author":"Phillips","year":"2016","journal-title":"Nutr. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bowlby, W., Zelnick, L.R., Henry, C., Himmelfarb, J., Kahn, S.E., Kestenbaum, B., Robinson-Cohen, C., Utzschneider, K.M., and de Boer, I.H. (2016). Physical activity and metabolic health in chronic kidney disease: A cross-sectional study. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0400-x"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2252093","DOI":"10.1080\/0886022X.2023.2252093","article-title":"The effect of aerobic exercise on oxidative stress in patients with chronic kidney disease: A systematic review and meta-analysis with trial sequential analysis","volume":"45","author":"Zhao","year":"2023","journal-title":"Ren. Fail."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Chen, C.-C., Huang, Y.-Y., Li, X.-Q., Long, Y.-Q., Chen, Z.-W., and Jin, T. (2024). Impact of resistance exercise on patients with chronic kidney disease. BMC Nephrol., 25.","DOI":"10.1186\/s12882-024-03547-5"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"de Geus, M., Dam, M., Visser, W.J., Ipema, K.J.R., de Mik-van Egmond, A.M.E., Tieland, M., Weijs, P.J.M., and Kruizenga, H.M. (2024). The impact of combined nutrition and exercise interventions in patients with chronic kidney disease. Nutrients, 16.","DOI":"10.3390\/nu16030406"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1681\/ASN.2008111205","article-title":"Bicarbonate supplementation slows progression of CKD and improves nutritional status","volume":"20","author":"Varagunam","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"371","DOI":"10.2215\/CJN.02430312","article-title":"A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate","volume":"8","author":"Goraya","year":"2013","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/ndt\/gfy214","article-title":"Correction of metabolic acidosis improves muscle mass and renal function in chronic kidney disease stages 3 and 4: A randomized controlled trial","volume":"35","author":"Dubey","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1007\/s40620-022-01560-1","article-title":"Gut microbiota disturbances and protein-energy wasting in chronic kidney disease: A narrative review","volume":"36","author":"Avesani","year":"2023","journal-title":"J. Nephrol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"International Scientific Association for Probiotics and Prebiotics (2020). The science of prebiotics. Cereal Foods World, 65, 27.","DOI":"10.1094\/CFW-65-3-0027"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Melekoglu, E., Cetinkaya, M.A., Kepekci-Tekkeli, S.E., Kul, O., and Samur, G. (2021). Effects of prebiotic oligofructose-enriched inulin on gut-derived uremic toxins and disease progression in rats with adenine-induced chronic kidney disease. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0258145"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Liu, C., Yang, L., Wei, W., and Fu, P. (2024). Efficacy of probiotics\/synbiotics supplementation in patients with chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1434613"},{"key":"ref_43","first-page":"152","article-title":"Use of probiotics in patients with chronic kidney disease on hemodialysis: A randomized clinical trial","volume":"45","author":"Meneses","year":"2022","journal-title":"Braz. J. Nephrol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"De Mauri, A., Carrera, D., Bagnati, M., Rolla, R., Vidali, M., Chiarinotti, D., Pane, M., Amoruso, A., and Del Piano, M. (2022). Probiotics-supplemented low-protein diet for microbiota modulation in patients with advanced chronic kidney disease (ProLowCKD): Results from a placebo-controlled randomized trial. Nutrients, 14.","DOI":"10.3390\/nu14081637"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2215\/CJN.05240515","article-title":"Synbiotics easing renal failure by improving gut microbiology (SYNERGY): A randomized trial","volume":"11","author":"Rossi","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1093\/ndt\/gfv095","article-title":"Altered intestinal microbial flora and impaired epithelial barrier structure and function in CKD: The nature, mechanisms, consequences, and potential therapeutic interventions","volume":"31","author":"Vaziri","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Mafra, D., Borges, N., Alvarenga, L., Esgalhado, M., Cardozo, L., Lindholm, B., and Stenvinkel, P. (2019). Dietary components that may influence the disturbed gut microbiota in chronic kidney disease. Nutrients, 11.","DOI":"10.3390\/nu11030496"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1159\/000526957","article-title":"Dietary protein and fiber affect gut microbiome and Treg\/Th17 commitment in chronic kidney disease mice","volume":"53","author":"Serrano","year":"2022","journal-title":"Am. J. Nephrol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Mertowska, P., Mertowski, S., Wojnicka, J., Korona-G\u0142owniak, I., Grywalska, E., B\u0142a\u017cewicz, A., and Za\u0142uska, W. (2021). A link between chronic kidney disease and gut microbiota in immunological and nutritional aspects. Nutrients, 13.","DOI":"10.3390\/nu13103637"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1038\/ki.2013.147","article-title":"Prevention and treatment of protein energy wasting in chronic kidney disease patients: A consensus statement by the International Society of Renal Nutrition and Metabolism","volume":"84","author":"Ikizler","year":"2013","journal-title":"Kidney Int."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1046\/j.1523-1755.2000.00886.x","article-title":"Recombinant human insulin-like growth factor-1 induces an anabolic response in malnourished CAPD patients","volume":"57","author":"Fouque","year":"2000","journal-title":"Kidney Int."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2020.05.006","article-title":"KDOQI clinical practice guideline for nutrition in CKD: 2020 update","volume":"76","author":"Ikizler","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Kaimori, J.-Y., Sakaguchi, Y., Oka, T., and Isaka, Y. (2025). Plant-dominant low-protein diets: A promising dietary strategy for mitigating disease progression in people with chronic kidney disease\u2014A comprehensive review. Nutrients, 17.","DOI":"10.3390\/nu17040643"},{"key":"ref_54","first-page":"254","article-title":"Latest consensus and update on protein-energy wasting in chronic kidney disease","volume":"18","author":"Obi","year":"2015","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1093\/ajcn\/69.1.30","article-title":"Cholesterol-lowering effects of dietary fiber: A meta-analysis","volume":"69","author":"Brown","year":"1999","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Kleinov\u00e1, P., Blichov\u00e1, T., Gra\u0148\u00e1k, K., Koll\u00e1r, A., Vnu\u010d\u00e1k, M., and Dedinsk\u00e1, I. (2024). Keto analogues in patients with chronic kidney disease with or without kidney transplantation. Nutrients, 16.","DOI":"10.3390\/nu16234001"},{"key":"ref_57","unstructured":"FAO\/WHO (2013). Dietary Protein Quality Evaluation in Human Nutrition: Report of An FAO Expert Consultation, FAO."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Apetrii, M., Timofte, D., Voroneanu, L., and Covic, A. (2021). Nutrition in chronic kidney disease\u2014The role of proteins and specific diets. Nutrients, 13.","DOI":"10.3390\/nu13030956"},{"key":"ref_59","unstructured":"USDA (2025, October 21). Food Data Central, Available online: https:\/\/fdc.nal.usda.gov\/."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2","DOI":"10.2478\/abm-2024-0002","article-title":"Plant-based diets in patients with chronic kidney disease","volume":"18","author":"Wathanavasin","year":"2024","journal-title":"Asian Biomed."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2215\/CJN.11901115","article-title":"Phosphate Toxicity in CKD: The Killer among Us","volume":"11","author":"Ritter","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"416","DOI":"10.3904\/kjim.2014.29.4.416","article-title":"Vitamin D and chronic kidney disease","volume":"29","author":"Kim","year":"2014","journal-title":"Korean J. Intern. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e74782","DOI":"10.7554\/eLife.74782","article-title":"Hyperphosphatemia increases inflammation to exacerbate anemia and skeletal muscle wasting independently of FGF23-FGFR4 signaling","volume":"11","author":"Czaya","year":"2022","journal-title":"eLife"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"221","DOI":"10.3164\/jcbn.23-9","article-title":"Dietary phosphate disturbs of gut microbiome in mice","volume":"73","author":"Oda","year":"2023","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"21446","DOI":"10.18632\/aging.103896","article-title":"High phosphate induces skeletal muscle atrophy and suppresses myogenic differentiation by increasing oxidative stress and activating Nrf2 signaling","volume":"12","author":"Chung","year":"2020","journal-title":"Aging"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Mocanu, C.A., Simionescu, T.P., Mocanu, A.E., and Garneata, L. (2021). Plant-based versus animal-based low protein diets in the management of chronic kidney disease. Nutrients, 13.","DOI":"10.3390\/nu13113721"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1159\/000371498","article-title":"The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease","volume":"40","author":"Moorthi","year":"2014","journal-title":"Am. J. Nephrol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Nogueira-Rio, N., Mondragon Portocarrero, A.d.C., Lamas Freire, A., Franco, C.M., Canbolat, A.A., Karav, S., and Miranda Lopez, J.M. (2025). Rethinking Nutrition in Chronic Kidney Disease: Plant Foods, Bioactive Compounds, and the Shift Beyond Traditional Limitations: A Narrative Review. Foods, 14.","DOI":"10.3390\/foods14193355"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Cedillo-Flores, R., Cuevas-Budhart, M.A., Cavero-Redondo, I., Kappes, M., \u00c1vila-D\u00edaz, M., and Paniagua, R. (2025). Impact of gut microbiome modulation on uremic toxin reduction in chronic kidney disease: A systematic review and network meta-analysis. Nutrients, 17.","DOI":"10.1101\/2025.02.21.25322662"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/j.ajcnut.2024.09.006","article-title":"Dietary plant-to-animal protein ratio and risk of cardiovascular disease in 3 prospective cohorts","volume":"120","author":"Glenn","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"62","DOI":"10.7812\/TPP\/14-036","article-title":"A plant-based diet, atherogenesis, and coronary artery disease prevention","volume":"19","author":"Tuso","year":"2015","journal-title":"Perm. J."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1042\/CS20190895","article-title":"Inflammation: A putative link between phosphate metabolism and cardiovascular disease","volume":"135","author":"Voelkl","year":"2021","journal-title":"Clin. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1017\/jns.2022.93","article-title":"Observational and clinical evidence that plant-based nutrition reduces dietary acid load","volume":"11","author":"Storz","year":"2022","journal-title":"J. Nutr. Sci."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1053\/j.jrn.2020.04.007","article-title":"Plant-based diets, the gut microbiota, and trimethylamine N-oxide production in chronic kidney disease: Therapeutic potential and methodological considerations","volume":"31","author":"Wiese","year":"2021","journal-title":"J. Ren. Nutr."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Zhang, Q., Wang, X., Jia, Y., Niu, Q., Ding, S., and Li, W. (2025). Effects of phytosterol-rich foods on lipid profile and inflammatory markers in patients with hyperlipidemia: A systematic review and meta-analysis. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1619922"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1093\/jn\/nxz020","article-title":"A meta-analysis of 46 studies identified by the FDA demonstrates that soy protein decreases circulating LDL and total cholesterol concentrations in adults","volume":"149","author":"Mejia","year":"2019","journal-title":"J. Nutr."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1053\/j.jrn.2018.06.006","article-title":"Adequacy of plant-based proteins in chronic kidney disease","volume":"29","author":"Joshi","year":"2019","journal-title":"J. Ren. Nutr."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Lin, Y.-L., Hou, J.-S., Wang, C.-H., Su, C.-Y., Liou, H.-H., and Hsu, B.-G. (2021). Effects of ketoanalogues on skeletal muscle mass in patients with advanced chronic kidney disease: Real-world evidence. Nutrition, 91\u201392, 111384.","DOI":"10.1016\/j.nut.2021.111384"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/3\/390\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T05:21:16Z","timestamp":1769491276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/3\/390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,24]]},"references-count":78,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["nu18030390"],"URL":"https:\/\/doi.org\/10.3390\/nu18030390","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,24]]}}}