There is not much research on vegans and kidney disease, and the VeganHealth.org page on Vegetarian Diets for People with Kidney Disease is fairly bare bones; mostly links to resources for people with kidney disease who want to be vegetarian.

However, a report on lacto-ovo vegetarians that could be important for kidney disease was released in April, so I decided to add it to the page. The addition is short, so I’ve reproduced it here:

“A 2012 study on lacto-ovo vegetarians, without kidney disease, found the urine of vegetarians to have a 60% lower amount of two different sulfates that are thought to be toxic and are problematic for patients with kidney disease (1). The lower amounts were thought to be due to a combination of lower protein intake, higher fiber intake, and difference in bacteria in the digestive tract.”

Resource

1. Patel KP, Luo FJ, Plummer NS, Hostetter TH, Meyer TW. The Production of p-Cresol Sulfate and Indoxyl Sulfate in Vegetarians Versus Omnivores. Clin J Am Soc Nephrol. 2012 Apr 5. [Epub ahead of print] Link

I’ve had a study on the acid load of vegan diets in my queue for awhile now and finally read it carefully. I just added this to the Bones, Vitamin D, and Calcium article at VeganHealth.org:

“Sulfur-containing amino acids are more prevalent in animal products, although they are also found in high amounts in many grains. A 2011 study from Germany tracked the diets of 98 vegans and 56 near-vegans for a week and used models to predict the effect of their diets on renal acid load. They found both diets to be neutral, whereas other studies show a typical omnivorous diet to be more acid producing (1).”

One thing that surprised me about this study was that they estimated that the vegans were consuming an average of 854 mg/day of calcium. That’s one of the higher estimates I’ve seen and the study didn’t indicate that they included supplements or calcium from fortified foods.

Since they merely estimated the acid load from models, rather than actually measuring it directly, the conclusion should be taken with some caution. And, as I’ve said many times before, the acid load of a vegan diet might not have all that much to do with the risk of osteoporosis for vegans – calcium and vitamin D appear to be much more important (see the link above on bones for more information).

Reference

1. Ströhle A, Waldmann A, Koschizke J, Leitzmann C, Hahn A. Diet-dependent net endogenous acid load of vegan diets in relation to food groups and bone health-related nutrients: results from the German Vegan Study. Ann Nutr Metab. 2011;59(2-4):117-26. Link

I see that you advocate higher intakes of proteins, but what about renal function? In the ADA Position I read:

This is the reference: ncbi.nlm.nih.gov/pubmed/17383270.1

Answer:

This is a legitimate concern.

Someone with kidney disease should be careful about protein intake. My recommendations for protein (Table 1 in the article Protein) are generally lower than what the population normally consumes, though higher than what many vegans might consume, and should be safe for someone without kidney problems, especially since some studies have shown vegetable protein to be less harmful than animal protein.

My recommendations for older people are a range from .8 to 1.3 g/kg/day. If someone has kidney disease, they might want to stick to the lower end of the range, or even lower than that if indicated during monitoring by their physician. And vegans should focus on high lysine protein foods to make sure they get enough of the amino acid lysine.

From time to time, I get messages from people on dialysis who want to know more about how to eat vegan while on dialysis. I send them to this short page of resources (link). But, I have never had any sort of ongoing communication with a vegan on dialysis.

I thought it could be helpful to start a page on this blog where vegans on dialysis can post about their experience and any hints they have. So if you are out there, please let us know how you’re doing and what you have learned.

Thank you!