Dietary interventions in acute kidney injury: From molecular mechanism to clinical trials

Ageing impairs renal resilience with an elevated risk of frequent and harmful acute kidney injury (AKI) that causes substantial morbidity and mortality among hospitalized patients. Since different damaging stimuli at the molecular, cellular and functional level contribute to this loss in kidney function, AKI's pathophysiology is heterogeneous and complex, and consequently, the development of pharmacological approaches is lagging behind. On the other hand, dietary interventions, such as caloric restriction, periodic fasting, ketogenic diets and restriction of sulfur-containing amino acids have shown immense potential in preserving kidney function in various rodent models of AKI. Deciphering the underlying, but conserved, molecular mechanisms or renal resilience in mice and humans will help to pave the way to successful transfer to the patient setting and may allow the identification of druggable targets. As these diet-induced protective effects of preconditioning are not limited to the kidney, dietary interventions may even be extended to other tissues like the brain or the heart in the context of AKI and beyond.