What dietary recommendations are suitable for someone with impaired renal function?

Dietary Recommendations for Chronic Kidney Disease

People with declining kidney function should adopt a plant-based diet with controlled protein intake of 0.8 g/kg body weight/day, reduced sodium (<2g/day), limited phosphorus and potassium, while maintaining adequate caloric intake (30-35 kcal/kg/day). 1

Protein Recommendations

Protein Intake Based on CKD Stage

• CKD G3-G5 (not on dialysis): 0.8 g/kg body weight/day 1, 2

  • Avoid high protein intake (>1.3 g/kg body weight/day) as it increases risk of progression 1
  • For motivated patients under close supervision, consider very low-protein diet (0.3-0.4 g/kg/day) supplemented with essential amino acids or ketoacid analogs 1

• CKD G5D (on dialysis): Higher protein intake of 1.0-1.2 g/kg body weight/day 2

• Special populations:

  • Children: Do not restrict protein; target upper end of normal range for healthy children 1
  • Older adults with frailty/sarcopenia: Consider higher protein and calorie targets 1

Protein Quality

• At least 50% of protein should be from high biological value sources 1
• Prioritize plant-based protein sources over animal-based proteins 1, 2

Dietary Components Beyond Protein

Sodium

• Limit sodium to <2 g/day (<5 g sodium chloride/day) 1
• Exception: Sodium restriction is not appropriate for patients with sodium-wasting nephropathy 1

Energy/Caloric Intake

• Adults <60 years: 35 kcal/kg body weight/day 1
• Adults ≥60 years: 30-35 kcal/kg body weight/day 1
• Adequate energy intake is crucial to prevent protein catabolism 2

Other Nutrients

• Monitor and restrict phosphorus and potassium based on serum levels 2
• May need calcium supplementation based on individual assessment 3

Dietary Pattern Recommendations

Recommended Dietary Pattern

• Plant-based diet with higher consumption of plant foods compared to animal foods 1
• Lower consumption of ultra-processed foods 1
• Mediterranean diet style has shown preventive effects on renal function and reduces disease progression 4

Foods to Emphasize

• Fruits and vegetables (with potassium monitoring) 2
• Whole grains (with phosphorus monitoring)
• Plant proteins (legumes, nuts, seeds with appropriate restrictions)
• Healthy fats (olive oil, avocados)

Foods to Limit

• High-sodium processed foods
• High-phosphorus foods (processed foods with phosphate additives, dairy)
• High-potassium foods if serum levels elevated
• Ultra-processed foods 1
• Excessive animal proteins 1, 2

Implementation and Monitoring

Dietary Management

• Consult with renal dietitians or accredited nutrition providers for individualized education 1
• Use 3-day food records to assess dietary intake 2
• Regular monitoring of nutritional status to prevent protein-energy malnutrition 2, 5
• Monitor appetite, body weight changes, biochemical data, and anthropometric measurements 2

Adherence Strategies

• Focus on one dietary goal at a time rather than multiple simultaneous changes 6
• Create active learning and coping strategies (e.g., meal preparation techniques) 6
• Adapt recommendations to changing lifestyle and CKD variables over time 6

Potential Benefits and Risks

Benefits

• May slow progression of kidney disease 1, 5
• Can help control metabolic derangements 5
• May delay need for dialysis initiation 2, 5
• Improves control of uremic symptoms 1

Risks

• Protein-energy wasting if caloric intake is inadequate 2, 5
• Overrestriction of protein (<0.3 g/kg/day) without proper supplementation increases mortality risk 2

Following these dietary recommendations under the supervision of a renal dietitian can significantly improve outcomes for people with declining kidney function while maintaining nutritional status.