From Awareness to Clinical Practice: Protein Knowledge, Dietary Behavior, and Implementation of a Plant-Dominant Low-Protein Diet (PLADO) in Cypriot Renal Patients.
Chronic kidney disease (CKD) represents a growing global public health challenge, with dietary management constituting a cornerstone of conservative treatment. Traditional low-protein diets (LPDs), although effective in slowing CKD progression, often rely heavily on animal-based protein sources, contributing to increased dietary acid load, phosphorus burden, and reduced long-term adherence. Emerging evidence supports plant-dominant dietary strategies; however, regionspecific clinical application within Mediterranean populations remains limited. The present multiphase study aimed to evaluate the clinical effectiveness and implementation feasibility of a culturally adapted plant-dominant low-protein diet (PLADO) in slowing CKD progression among Cypriot patients, compared to a conventional low-protein dietary approach. The research design comprised four integrated phases: (1) a comprehensive literature review establishing the scientific rationale for PLADO; (2) development and validation of a questionnaire assessing protein-related knowledge, dietary behaviors, and perceptions; (3) a cross-sectional baseline analysis evaluating Mediterranean diet adherence, anthropometric indices, and CKD prevalence; and (4) a nine-month controlled intervention study involving 60 adults with CKD allocated to either a PLADO group or a conventional KDOQI-based low-protein diet group. Renal biomarkers—including estimated glomerular filtration rate (eGFR), serum creatinine, and serum urea—were measured alongside metabolic and inflammatory parameters such as serum phosphorus, potassium, lipid profile, acid–base balance, hemoglobin, albumin, and C-reactive protein (CRP). Multivariable logistic regression and ROC curve analyses were performed where applicable. 3 The questionnaire phase revealed significant variability in nutrition literacy, with notable knowledge gaps among younger and less-educated participants. Higher Mediterranean diet adherence was independently associated with lower odds of CKD (OR = 0.81, p < 0.001). In the intervention phase, the PLADO group demonstrated clinically meaningful improvements in key renal biomarkers, including greater reductions in serum creatinine and urea levels and a more pronounced increase in eGFR compared to the conventional low-protein diet group. Notably, inflammatory status improved substantially in the PLADO group, with marked reductions in CRP levels, suggesting potential anti-inflammatory effects of plant-dominant protein sources. Improvements were also observed in lipid profile parameters and acid–base balance, while electrolyte stability indicated metabolic safety and absence of clinically significant hyperkalemia. Although not all outcomes reached statistical significance, the direction and magnitude of biomarker changes consistently favored the PLADO intervention. Overall, this study provides preliminary clinical and contextual evidence supporting the feasibility, safety, and potential nephroprotective properties of a culturally adapted plant-dominant lowprotein diet within a Mediterranean CKD population. By integrating biomarker monitoring, nutrition literacy assessment, and sustainability considerations, the findings contribute to the evolving field of precision renal nutrition. Larger randomized controlled trials are warranted to confirm long-term efficacy and generalizability, but the present research establishes an important foundation for implementing plant-dominant dietary strategies in CKD management.
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From Awareness to Clinical Practice: Protein Knowledge, Dietary Behavior, and Implementation of a Plant-Dominant Low-Protein Diet (PLADO) in Cypriot Renal Patients. - Identifier: 6638
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