Ultra-processed Foods and Food Additives in CKD: Unveiling Hidden Risks and Advocating Smarter Food Choices

The term ultra-processed food (UPF) was developed almost two decades ago to define foods which have undergone sophisticated industrial processing. Many of these foods contain added sugars, unhealthy fats, salt, and food additives designed to enhance palatability, extend shelf life, and drive high sales. Due to these convenient characteristics, the sales and consumption of UPF have consistently increased, with the tendency to replace minimally processed foods in the diet. This shift has led to a decrease in dietary quality and to an increase in the consumption of sugars, unhealthy fats, salt and food additives, the latter raising concerns about potential toxicity. Therefore, UPF consumption has been associated with increased risk of developing non-communicable diseases, including chronic kidney disease (CKD), and may have an impact on kidney health in each CKD stage. Primary caregivers should be aware that UPF increases the risk of developing CKD. Providers of secondary and tertiary care should note that UPF contributes to the development of metabolic derangements such as metabolic acidosis, hyperkalemia, hyperphosphatemia, dyslipidemia and dysbiosis. This Review provides a summary of the main adverse effects of UPFs on general health as well as on kidney health. In addition, it gives practical guidance on how to define and assess UPF intake in research and clinical settings, with proposed strategies on how to address UPF consumption in individuals with CKD stages 3 to 5, aiming at reducing UPF consumption and increasing intake of minimally processed healthier food.