Recommended Diet for Chronic Kidney Disease (CKD)
For patients with CKD, a diet providing 0.6-0.8 g protein/kg body weight/day is recommended to maintain nutritional status while slowing disease progression. 1, 2
Protein Recommendations Based on CKD Stage
- For CKD stages 1-2: 0.8 g protein/kg/day to prevent excessive protein intake while maintaining nutritional status 2, 3
- For CKD stages 3-5 (not on dialysis): 0.6-0.8 g protein/kg/day to slow progression and minimize uremic toxin accumulation 1, 2, 4
- For CKD stage 5D (on dialysis): 1.0-1.2 g protein/kg/day to maintain stable nutritional status 1, 2
- For diabetic kidney disease: 0.6-0.8 g protein/kg/day to maintain nutritional status and optimize glycemic control 1, 5
Energy Intake
- Recommended energy intake: 25-35 kcal/kg body weight/day based on age, sex, physical activity level, and body composition 1
- For patients under 60 years: 35 kcal/kg/day 1
- For patients 60 years or older: 30-35 kcal/kg/day due to typically lower activity levels 1
Dietary Components and Restrictions
- Sodium: Limit to <2.3 g/day to help control blood pressure 1, 2
- Phosphorus: Restrict to 0.8-1.0 g/day in advanced CKD stages 1, 2
- Potassium: Restrict to 2-4 g/day in advanced CKD stages 1
- Fat: Limit total fat to <30% of calories and saturated fat to <10% of calories 1
- Carbohydrates: Should comprise 50-60% of total calories 1
Protein Sources and Diet Type
- Plant-based protein sources are recommended for at least 50% of protein intake (PLADO - plant-dominant low-protein diet) 6
- Mediterranean diet may improve lipid profiles in CKD patients 1
- Increased fruit and vegetable intake may decrease body weight, blood pressure, and net acid production 1
- Reduce meat consumption and use low-fat or nonfat dairy products 1
Special Considerations
- Very low-protein diets (0.28-0.43 g/kg/day) supplemented with keto acid/amino acid analogs may be considered for high-risk patients under close supervision 1, 2
- Avoid high-protein diets (>1.3 g/kg/day) as they may accelerate CKD progression 2, 7
- For patients with protein-energy wasting, consider oral nutritional supplements for at least 3 months 1
- Enteral tube feeding or parenteral nutrition may be necessary if dietary counseling and oral supplements are insufficient 1
Common Pitfalls to Avoid
- Implementing protein restriction without proper nutritional counseling can lead to malnutrition 3
- Focusing solely on protein restriction without addressing overall diet quality may be counterproductive 3
- Patients on low-protein diets must be monitored regularly for signs of protein-energy wasting 2
- Inadequate energy intake while restricting protein can lead to catabolism and poor nutritional status 1
Monitoring Recommendations
- Regular assessment of nutritional status through appetite evaluation, dietary intake, body weight changes, and biochemical data 2
- Monitor serum albumin, prealbumin, and body composition to ensure adequate nutritional status 2
- Monitor electrolytes, particularly potassium and phosphorus, which may be affected by dietary changes 2
Nutritional intervention should be individualized and managed by a specialty-trained registered dietitian with expertise in CKD nutrition 1, 2.