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The impact of diet and body weight management on the progression and treatment of kidney disease: (Master thesis)

Ιωακειμίδου, Σουζάνα/ Ioakeimidou, Souzana/ Μεθοδολογία της Σύγχρονης Αντιμετώπισης της Νεφρικής Ανεπάρκειας

This thesis explores the role of nutrition in Chronic Kidney Disease (CKD), focusing on both the pathophysiological mechanisms of the disease and contemporary nutritional and holistic interventions that contribute to improving clinical outcomes and patients’ quality of life. The study is based on current international clinical practice guidelines, as well as recent scientific evidence regarding nutritional assessment, dietary patterns, and the metabolic disturbances associated with CKD. Initially, the anatomy and physiology of the kidneys are presented, alongside their fundamental role in fluid and electrolyte homeostasis and the mechanisms through which declining kidney function leads to metabolic and nutritional disorders. Particular emphasis is placed on the regulation of sodium, potassium, phosphorus, and calcium, as well as on the effects of CKD on acid–base balance, bone metabolism, and the development of cardiovascular complications. In parallel, the mechanisms underlying protein-energy wasting, sarcopenia, and malnutrition are analyzed, as these conditions significantly affect patients’ prognosis and quality of life. Subsequently, the principles of nutritional management in CKD are discussed, including recommendations regarding protein, energy, micronutrient, and fluid intake. Special attention is given to low-protein diets, plant-based dietary approaches, and the importance of protein quality, as well as to the role of dietary patterns such as the Mediterranean diet and the DASH diet in slowing disease progression and reducing inflammation and cardiovascular risk. Furthermore, the importance of systematic nutritional assessment is highlighted through the use of tools evaluating dietary intake, body composition, and muscle function, aiming at the early identification of nutritional deficiencies and the individualization of nutritional interventions. The special part of the thesis includes the conduct of an umbrella review aiming to collect, evaluate, and synthesize the available systematic reviews and meta-analyses regarding nutritional and holistic interventions in CKD. More specifically, evidence related to dietary patterns, low-protein and plant-based diets, as well as interventions involving physical activity, stress management, and quality of life improvement in CKD patients is examined. Through the synthesis of the available scientific evidence, the study seeks to assess the level of evidence supporting these interventions and to highlight their potential clinical benefits on kidney function, nutritional status, and overall patient outcomes. Finally, the thesis approaches CKD from a holistic perspective by examining the relationship between the disease, chronic stress, mental health, and quality of life, emphasizing the need for interdisciplinary care and individualized nutritional support. Overall, the study highlights that nutrition constitutes a fundamental pillar both in the prevention and slowing of CKD progression and in the improvement of the overall health and daily life of individuals living with the disease.