From the Guidelines
For a patient with stage 3 CKD and pressure ulcers, a protein-modified diet with 0.8 g/kg/day of high-quality protein is recommended to support wound healing while protecting kidney function, as evidenced by the most recent guidelines 1. The dietary arrangement should prioritize kidney protection while supporting tissue repair, as excessive protein can accelerate kidney damage through increased nitrogenous waste, while insufficient protein impairs wound healing.
- Key considerations include:
- Restricting dietary sodium to <2,300 mg/day to control blood pressure and reduce cardiovascular risk 1
- Individualizing dietary potassium intake based on serum levels and kidney function 1
- Maintaining adequate caloric intake to prevent protein catabolism, with a daily caloric intake of 30-35 kcal/kg 1
- Monitoring and potentially restricting phosphorus intake to 800-1000 mg/day to prevent hyperphosphatemia 1
- Ensuring adequate fluid intake, individualized but generally maintained at 2-3 liters daily unless edema is present 1
- Considering supplementation with water-soluble vitamins, such as vitamin C and zinc, to support wound healing 1 Regular monitoring of serum albumin, BUN, creatinine, electrolytes, and wound healing progress is essential to adjust the diet as needed, as supported by the guidelines from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) and the International Society of Renal Nutrition and Metabolism 1.
From the Research
Dietary Arrangements for Stage 3 CKD and Pressure Ulcers
Based on biochemical studies, the following dietary arrangements are recommended for patients with stage 3 Chronic Kidney Disease (CKD) and pressure ulcers:
- Energy and protein supplements may result in little to no difference in the proportion of participants developing a pressure ulcer, but may slightly increase the number of healed pressure ulcers 2
- Protein supplements may result in little to no difference in pressure ulcer incidence, but the evidence is very uncertain about the effects of protein, arginine, zinc, and antioxidant supplements on pressure ulcer healing 2
- A high-protein oral nutritional supplement (ONS) enriched with arginine, vitamin C, vitamin E, and zinc, when used with standard pressure ulcer care, significantly reduced the mean pressure ulcer area of long-term nursing home residents 3
- Vitamin C and zinc supplementation, in combination with arginine, may improve the healing of pressure ulcers, but the evidence for prevention of pressure ulcers by such supplements is comparably low 4
Key Nutrients for Pressure Ulcer Healing
The following nutrients may be beneficial for pressure ulcer healing:
- Protein: essential for wound healing and may be beneficial in combination with other nutrients 2, 3
- Arginine: may improve wound healing and is often used in combination with other nutrients 3, 4
- Vitamin C: important for collagen synthesis and may be beneficial in combination with other nutrients 3, 4
- Zinc: essential for wound healing and may be beneficial in combination with other nutrients 3, 4
Blood Pressure Goals for CKD Patients
For patients with CKD, a blood pressure goal of <130/80 mm Hg is recommended, as it may reduce the risk of cardiovascular disease and mortality 5