# Dietary Transitions and the Rising Global Burden of Chronic Kidney Disease: Insights from Nutritional Epidemiology

## TL;DR

This paper explores how modern diets, especially those high in ultra-processed foods, may be driving the global rise in chronic kidney disease.

## Contribution

The paper novelly connects dietary transitions with chronic kidney disease through multiple interconnected biological pathways.

## Key findings

- Healthier diets like Mediterranean and DASH are linked to lower CKD risk and slower disease progression.
- Western diets rich in ultra-processed foods are associated with increased CKD risk and worse cardiometabolic outcomes.
- New mechanisms like gut dysbiosis and dietary acid load are identified as contributors to CKD.

## Abstract

Background/Objectives: Chronic kidney disease (CKD) is one of the fastest-growing non-communicable diseases globally, with a disproportionate burden in populations undergoing rapid dietary and epidemiological transitions. Beyond traditional clinical risk factors, increasing evidence from nutritional epidemiology suggests that contemporary dietary environments may play a significant role in shaping CKD risk, complications, and progression. This narrative review examines CKD as a potential unintended consequence of global dietary transitions, with particular emphasis on ultra-processed foods and overall diet quality. Methods: A structured narrative review was conducted using evidence from prospective cohort studies, systematic reviews, meta-analyses, and mechanistic research. Findings were synthesized within a population-health framework integrating dietary patterns, food processing classification, and biologically plausible pathways relevant to kidney health. Results: Healthier dietary patterns, including Mediterranean, DASH, and plant-forward diets, are consistently associated with lower risk of incident CKD, slower kidney function decline, and reduced mortality. In contrast, Western dietary patterns characterized by high intake of ultra-processed foods are linked to increased CKD risk and adverse cardiometabolic outcomes. Beyond mediators such as hypertension, diabetes, and obesity, emerging mechanisms include dietary acid load, gut dysbiosis and uremic toxin production, sodium density, and exposure to highly bioavailable phosphate additives. Conclusions: Dietary transitions toward ultra-processed, low-fiber, sodium- and additive-rich food environments may contribute to the growing global burden of CKD through interconnected metabolic, inflammatory, and gut–kidney pathways. Improving diet quality and addressing food processing at the population level represent promising opportunities for CKD prevention and risk reduction.