The Role of Precision Nutrition in Kidney Disease.

Precision nutrition utilizes an individualized approach in which dietary interventions are tailored according to patients' genetic, biologic, and environmental factors. There are various nutritional guidelines specific to chronic kidney disease (CKD) patients, and while rigorous, they provide generalized recommendations that may not fully address the unique nutritional needs of individual patients. For example, while guidelines endorse prescription of low-protein diets among people with metabolically-stable stages 3-5 non-dialysis dependent CKD to reduce kidney disease progression, these recommendations do not fully account for the genetic, metabolic, or physiologic factors that affect how different patients respond to specific dietary interventions. Furthermore, older patients with CKD may require different levels of protein intake compared to younger individuals, given that aging affects protein metabolism. In contrast to conventional nutritional management approaches, which typically utilize a one-size-fits-all model, precision nutrition and personalized nutrition utilize an individualized approach. While the terms precision nutrition and personalized nutrition are sometimes used interchangeably, there are nuanced differences in their definitions such that precision nutrition is more data-driven and utilizes precise information (e.g., genetic, microbiome, metabolic) to inform management, whereas personalized nutrition encompasses a broader approach that also takes into consideration factors such as lifestyle, environment, and patients' preferences. Precision nutrition is evolving rapidly with advances in data collection, deep data analysis, and modeling with application of artificial intelligence, while personalized nutrition is what we practice today leveraging available data and guidelines to meet each individual patient's needs. Numerous advancements have led to a growing armamentarium of tools in precision nutrition, including nutrigenetics, nutrigenomics, microbiome profiling, metabolomics, and proteomics, which can be leveraged to guide dietary recommendations according to an individual's unique characteristics. In this Review, we examine the role of precision nutrition in CKD, tools used in precision medicine, and practical application of these approaches in treating kidney disease patients.