These findings are in line with existing studies, which consistently report consuming a diet that emphasizes plant foods and is low in animal products has cardiometabolic benefits, including a lower risk for CKD. The study found broadly consistent results across individuals with genetic predisposition to develop CKD, baseline kidney function, BMI and education level (a marker of socioeconomic status), which provides support for following diets high in high-quality plant foods, such as whole grains, fruits, vegetables, and low in animal products.

As the authors noted, this definition used a combination of consumption frequency and exclusion of animal products. Meat eaters were classified using consumption frequency while pescatarians, poultry eaters and vegetarians were classified using exclusion of certain animal products. Such a definition might not capture flexitarians (individuals who adhere to a vegetarian diet on an inconsistent basis, such as once or twice per week), does not use the full range of intake of plant foods and animal products consumed in a population, and could lead to a very small number of vegans in the study population. In fact, the authors found a low number of vegans, which led them to combine vegetarians and vegans into a single category. The definition has some limitations, which the authors appropriately acknowledge. Nonetheless, the results of this study still provide an important contribution to the literature on the role of dieting for the primary prevention of CKD.

It would also be interesting to see whether the duration of adhering to a vegetarian diet is associated with lower risk for CKD. In this study, dietary intake was assessed only at a single time point, which makes it impossible to conduct such analyses. It is important to characterize dietary intake of vegetarians and vegans and understand what kinds of foods they are eating. The authors did this somewhat by examining macro- and micronutrient intake among different diet groups, but it would also be helpful to see whether vegetarians and vegans are consuming more vegetables, fruits and whole grains.

Disclosures: Kim reports no relevant financial disclosures.

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