Dietary Recommendations for Patients with Chronic Kidney Disease
Patients with chronic kidney disease should adopt a plant-dominant diet with moderate protein restriction (0.8 g/kg/day for adults with CKD G3-G5), limited sodium intake (<2g/day), and reduced consumption of ultra-processed foods. 1
Core Dietary Principles for CKD
Protein Intake
For adults with CKD G3-G5:
- Maintain protein intake at 0.8 g/kg body weight/day 1
- Avoid high protein intake (>1.3 g/kg/day) in those at risk of CKD progression 1
- For patients at high risk of kidney failure: Consider very low protein diet (0.3-0.4 g/kg/day) with essential amino acid or ketoacid supplementation, under close supervision 1, 2
Special populations:
- Children: Do NOT restrict protein due to growth impairment risk; target upper end of normal range 1
- Older adults with frailty/sarcopenia: Consider higher protein and calorie targets 1, 2
- Metabolically unstable patients: Do NOT prescribe low/very low protein diets 1
- Dialysis patients: Higher protein requirements (1.2 g/kg/day for hemodialysis, 1.2-1.3 g/kg/day for peritoneal dialysis) 2, 3
Sodium Intake
- Limit sodium to <2g/day (<5g sodium chloride/day) 1
- Exception: Sodium restriction not appropriate for patients with sodium-wasting nephropathy 1
- For children with BP >90th percentile: Follow age-based Recommended Daily Intake 1
Overall Diet Composition
- Emphasize plant-based foods over animal-based foods 1, 4
- Minimize ultra-processed foods 1
- Plant-dominant low-protein diets (PLADO) offer additional benefits 4, 5:
- Reduced uremic toxin production through increased fiber intake
- Better correction of metabolic acidosis and hyperphosphatemia
- Less glomerular hyperfiltration compared to animal proteins
- Increased magnesium intake (may prevent vascular calcification)
Implementation Approach
Nutritional Assessment and Monitoring
- Refer to renal dietitians for individualized dietary education 1
- Focus education on sodium, phosphorus, potassium, and protein modifications 1
- Regular nutritional assessment to prevent protein-energy wasting 2
- Ensure adequate energy intake (30-35 kcal/kg/day) to maintain nitrogen balance 2
- Monitor:
- Serum albumin levels
- Body weight changes
- Renal function and proteinuria 2
Clinical Benefits of Dietary Management
- Protein restriction can delay kidney failure progression (32% reduction in renal death) 6
- Plant-dominant diets may improve:
- Gut microbiome composition
- Cardiovascular risk factors
- Constipation (reducing hyperkalemia risk) 5
- Proper dietary management can reduce uremic symptoms and delay dialysis initiation 7
Common Pitfalls and Caveats
- Overly restrictive diets can lead to malnutrition and protein-energy wasting 2
- Poor adherence to dietary restrictions is common - work with dietitians to improve palatability and variety 7
- Protein requirements vary by CKD stage, dialysis status, and individual factors 2, 3
- Metabolic status must be considered before implementing protein restriction 1
- Dietary changes should be implemented alongside other CKD management strategies (BP control, physical activity, weight management) 1
By following these evidence-based dietary recommendations, patients with CKD can potentially slow disease progression, reduce complications, and improve quality of life.