Food as medicine for CKD: Implications for disadvantaged populations

Persons with or at risk for chronic kidney disease (CKD) and their healthcare clinicians seek ways to prevent adverse kidney outcomes. Recent studies highlight that specific healthful dietary patterns may lead to favorable kidney outcomes; these include dietary patterns rich in fruits and vegetables such as the Mediterranean diet, the Dietary Approaches to Stop Hypertension diet, and dietary patterns low in dietary acid load. However, for many socioeconomically disadvantaged individuals, healthful dietary patterns are inaccessible due to inability to afford or access healthful foods. Barriers may exist at multiple levels, including the individual level (e.g., knowledge and beliefs about healthful eating habits) and the institutional level (e.g., rules and regulations about healthy food availability and cost). In this review, recent studies are described that document dietary patterns that may promote kidney health. A framework for considering barriers and facilitators of healthful eating among disadvantaged individuals modified from the social ecological model is offered, and their potential impact on kidney diseases is discussed. Recent epidemiologic and intervention studies addressing dietary factors in the setting of chronic kidney disease and other conditions are detailed. Finally, knowledge gaps in intervention studies, evaluation of public programs, and advocacy efforts are discussed towards promoting "food as medicine" to support kidney health for all.