Malnutrition is a serious and widespread problem among patients undergoing peritoneal dialysis (PD), a type of kidney replacement therapy, affecting nearly half of all patients in this population. A new randomized controlled trial launching in Malaysia is investigating whether shifting from animal-based to plant-based proteins could improve nutritional outcomes and quality of life for these vulnerable patients.

Peritoneal dialysis is a life-sustaining treatment for people with end-stage renal disease (ESRD), a condition where the kidneys no longer function well enough to sustain life. However, the treatment itself comes with a significant nutritional challenge. According to recent data, malnutrition affects 45.3% of patients undergoing PD globally, making it the highest prevalence among all dialysis populations. In Malaysia specifically, the situation is equally concerning: only 27% of PD patients meet recommended targets for both body weight and blood protein levels, while more than 70% are classified as malnourished across multiple assessment measures.

Why Do Dialysis Patients Struggle With Malnutrition?

The causes of malnutrition in PD patients are complex and multifaceted. Patients lose nutrients through the dialysate fluid used in treatment, experience poor appetite, and face metabolic imbalances that make it harder for their bodies to absorb and use nutrients effectively. Additionally, the chronic inflammation that accompanies kidney disease creates a hypercatabolic state, meaning the body burns through nutrients faster than normal.

Current dietary guidelines for dialysis patients emphasize adequate protein intake, but they are predominantly animal-based. This approach raises concerns because animal proteins may worsen inflammation and metabolic complications in this already vulnerable population. Researchers have begun exploring whether plant-focused diets might offer a safer alternative.

What Does the Research Show About Plant-Based Proteins for Dialysis Patients?

Emerging evidence suggests that plant-based diets may offer several benefits for dialysis patients without the risks traditionally associated with plant foods in this population. Recent studies indicate that increasing plant consumption can reduce blood pressure, decrease metabolic acidosis (a dangerous buildup of acid in the blood), and lower gut-derived uremic toxins, which are harmful compounds that accumulate in kidney disease.

One of the biggest concerns doctors have about plant-based diets in dialysis patients is the risk of hyperkalemia, a dangerous elevation of potassium in the blood. However, emerging research suggests that plant-focused diets may not significantly raise serum potassium levels, addressing a major safety concern that has previously limited dietary options for this population.

How to Support Better Nutrition in Dialysis Patients

• Individualized Dietary Counseling: Plant-focused interventions should be tailored to meet each patient's specific nutrient requirements through one-on-one sessions with registered dietitians, not generic dietary advice.
• Regular Monitoring and Follow-Up: Patients need ongoing assessment of their nutritional status, including blood tests for albumin levels, potassium, phosphorus, and inflammatory markers at regular intervals to ensure the diet is working safely.
• Educational Support and Materials: Patients benefit from educational resources that explain how to select plant-based proteins, prepare meals, and understand portion sizes appropriate for their kidney condition.
• Comprehensive Health Assessment: Monitoring should include physical function, quality of life measures, and metabolic control to ensure the dietary intervention improves overall health outcomes, not just individual nutrient levels.

To address the evidence gap in renal nutrition management, researchers at Universiti Kebangsaan Malaysia are conducting a rigorous randomized controlled trial comparing plant-focused diets with standard animal-based renal diets in malnourished PD patients. The study, which began recruiting participants in March 2026, will enroll 100 adult outpatients and follow them for six months.

The trial will measure changes in serum albumin, a key marker of protein nutrition, along with other important indicators. Researchers will assess renal function, glucose control, lipid profiles, inflammatory markers, malnutrition inflammation scores, dietary adequacy, physical activity and function, quality of life, and patients' knowledge and attitudes about their renal diet.

The study represents a significant step forward because most existing evidence on plant-based diets comes from general populations, not from people with kidney disease. The specific needs of dialysis patients are quite different from the general public, making targeted research essential. As of the manuscript submission date, nine participants had been recruited, with the study expected to be completed by March 2027.

This research addresses a critical gap in nutrition science. The Frontiers in Nutrition journal has identified nutritional strategies for managing sarcopenia, a condition involving muscle wasting common in dialysis patients, as a priority research area for 2025 and beyond, highlighting the urgency of finding effective dietary interventions for this vulnerable population.

For dialysis patients and their families, the potential implications are significant. If plant-focused diets prove effective and safe, they could offer a new dietary approach that reduces inflammation, improves nutritional status, and enhances quality of life without the complications that have previously limited dietary options. The results of this trial may reshape how nutritionists counsel patients with kidney disease, moving beyond the traditional animal-protein-focused approach to a more balanced, plant-inclusive strategy tailored to the unique needs of the dialysis population.