From the Guidelines
For patients with chronic kidney disease (CKD), a balanced diet that is high in vegetables, fruits, whole grains, fiber, legumes, plant-based proteins, unsaturated fats, and nuts, and lower in processed meats, refined carbohydrates, and sweetened beverages is recommended. This dietary approach is supported by the most recent evidence from the 2025 Diabetes Care guidelines 1. The recommended daily protein intake for individuals with stages 3-5 non-dialysis-dependent CKD is 0.8 g/kg body weight per day, which can help slow the decline in kidney function.
Key components of the diet include:
- Protein intake of 0.8 g/kg body weight per day for most adults with CKD not on dialysis
- Sodium intake limited to less than 2,300 mg/day to manage blood pressure and reduce cardiovascular risk
- Individualized dietary potassium intake to manage serum potassium concentrations
- Phosphorus intake controlled by reducing dairy, nuts, and processed foods with phosphate additives
- Fluid restrictions based on urine output and CKD stage
It is essential to work with a renal dietitian to create an individualized meal plan that takes into account lab values, CKD stage, and other health conditions. This personalized approach can help slow CKD progression, prevent electrolyte imbalances, and control complications like hypertension and bone disease.
From the Research
Dietary Recommendations for CKD
The optimal diet for patients with Chronic Kidney Disease (CKD) is crucial in managing the progression of the disease. Key recommendations include:
- Restricting dietary protein intake to 0.6 g/kg of ideal body weight/day to slow down the progression of CKD 2
- Limiting sodium intake to 5-6 g/d to optimize the treatment of hypertension associated with CKD and to limit fluid overload 2
- Restricting phosphorus and potassium intake at advanced stages of CKD 2
- Consuming a moderate amount of protein, with a focus on vegetable protein to decrease serum phosphorus, uremic toxins, and kidney damage 3
- Maintaining a calorie intake of 30-35 kcal/kg of ideal body weight/day to reduce the risk of malnutrition and maintain a neutral nitrogen balance 2
Nutrient-Specific Considerations
Specific nutrients play a significant role in CKD management:
- Protein: Low- and very-low-protein diets have been shown to improve biochemical markers of CKD-MBD, including reductions in phosphorus, parathyroid hormone, and fibroblast growth factor-23 4
- Sodium: Restricting sodium intake is essential in managing hypertension associated with CKD 5, 6
- Potassium: Restricting potassium intake may be necessary at advanced stages of CKD 2
- Phosphorus: Restricting phosphorus intake is crucial in minimizing vascular calcification, particularly at advanced stages of CKD 2, 3
- Calcium: Dietary calcium restriction may be necessary to minimize vascular calcification 3
Importance of Expert Guidance
Given the complexity of optimal renal diet, coordination between general practitioners, nephrologists, and dietitians is essential to foster optimal care 2. Regular consultation with an expert dietitian is required to prevent the development and progression of CKD and protein-energy wasting (PEW) 6.