Dietary Recommendations for Chronic Kidney Disease
Patients with CKD should maintain a protein intake of 0.8 g/kg body weight/day, consume a plant-dominant diet high in vegetables, fruits, whole grains, and fiber while limiting processed meats and refined carbohydrates, and restrict sodium to less than 2 g/day. 1
Protein Management
Standard Protein Intake
Maintain 0.8 g/kg body weight/day for adults with CKD G3-G5 (stages 3-5) who are not on dialysis. 1, 2 This represents the recommended daily allowance and has been shown to slow GFR decline with evidence of greater effect over time. 1
Avoid high protein intake exceeding 1.3 g/kg body weight/day. 1, 2 Higher protein consumption is associated with increased albuminuria, more rapid kidney function loss, and cardiovascular mortality. 1
Special Populations Requiring Modified Protein Targets
Dialysis patients: Increase protein to 1.0-1.2 g/kg body weight/day for both hemodialysis and peritoneal dialysis patients to counteract protein catabolism and dialysate losses. 1, 3
Older adults with frailty or sarcopenia: Consider higher protein and calorie targets to prevent muscle wasting and malnutrition. 1, 2
Very low-protein diets: For willing and able patients at high risk of kidney failure, prescribe 0.3-0.4 g/kg body weight/day supplemented with essential amino acids or ketoacid analogs (up to 0.6 g/kg body weight/day) under close supervision. 1, 3, 2 This approach requires metabolic stability and should never be used in unstable patients. 1
Dietary Pattern Recommendations
Plant-Dominant Diet Composition
Adopt a diet high in vegetables, fruits, whole grains, fiber, legumes, plant-based proteins, unsaturated fats, and nuts. 1 This dietary pattern is associated with reduced risk of CKD progression and related complications including metabolic acidosis and mineral bone disorders. 4
Reduce consumption of processed meats, refined carbohydrates, sweetened beverages, and ultraprocessed foods. 1 These foods contribute to dietary acid load and adverse CKD outcomes. 5
Sodium Restriction
Limit sodium intake to less than 2 g/day (equivalent to <90 mmol/day or <5 g sodium chloride/day). 1 This target helps control blood pressure and reduces cardiovascular risk. 1
Exception: Do not restrict sodium in patients with sodium-wasting nephropathy, as restriction is inappropriate in this population. 1
Potassium and Phosphorus Management
Individualize potassium intake based on serum levels, eGFR, and medication use. 1 Patients with reduced eGFR have impaired urinary excretion requiring careful monitoring. 1
Work with renal dietitians to adjust phosphorus intake tailored to CKD severity and mineral bone disorder status. 1
Implementation Strategy
Professional Nutrition Support
Engage renal dietitians or accredited nutrition providers for education about dietary adaptations. 1, 2 These professionals should tailor recommendations to individual needs, CKD severity, and comorbid conditions. 1
Consider cultural differences, food intolerances, food resource variations, cooking skills, comorbidities, and cost when recommending dietary options. 1 This individualized approach improves adherence and quality of life. 6
Monitoring Requirements
Ensure energy intake of 25-35 kcal/kg body weight/day to maintain normal nutritional status. 3 Monitor through appetite assessment, dietary intake evaluation, body weight changes, biochemical data, and anthropometric measurements. 3
Watch for protein-energy wasting, which is associated with increased morbidity and mortality. 3 Monitor serum albumin, prealbumin, and body composition regularly. 3
Critical Pitfalls to Avoid
Never implement protein restriction without proper nutritional counseling and monitoring. 3, 2 This can lead to malnutrition and worse outcomes.
Do not prescribe low or very low-protein diets in metabolically unstable patients. 1, 3 These patients require adequate protein for healing and metabolic demands.
Avoid focusing solely on protein restriction without addressing overall diet quality including sodium, phosphorus, and potassium. 3, 2 A comprehensive approach is essential for optimal outcomes.
Do not restrict protein in children with CKD due to risk of growth impairment. 1 Children require protein at the upper end of normal range for healthy growth.