HIGH-PROTEIN diets have been shown to accelerate renal deterioration in a number of studies of populations with even mildly reduced kidney function.

Protein malnutrition develops in CKD patients frequently, especially those on chronic hemodialysis. In these patients, low serum albumin (less than 3.5 mg/dL) is closely linked to inflammation, which is strongly associated with morbidity and mortality.

Protein malnutrition occurs frequently in patients on hemodialysis. When patient assessment indicates protein malnutrition, increased protein intake is recommended. Even if protein intake appears to be adequate, inadequate intake of foods providing energy (fats and carbohydrates) can lead to protein malnutrition because protein will be metabolized to provide energy. So both adequate protein and energy intake are necessary.

THE ROLE OF meat consumption in the development of kidney stones remains controversial. Most of the recent research on this topic has focused on the effect of dietary protein on acid-base metabolism, calcium excretion, and uric acid production.

Until relatively recently, little attention was given to a patient’s vitamin D status because it was assumed that with sun exposure, the skin could synthesize adequate amounts of the nutrient. But as TV viewing, video gaming, Internet surfing, and other indoor activities have surged in popularity, Americans are getting less sun.

MEASURED BY glycosylated hemoglobin A1c (HbA1c), poor diabetic metabolic control correlates with the complications such as nephropathy, as demonstrated in two important studies, the Diabetes Control and Complications Trial and the U.K. Prospective Diabetes Study. Therefore, it should come as no surprise that inadequate glycemic control in diabetic patients not on dialysis is associated with greater macrovascular complications, including MI, stroke, and peripheral vascular disease.

CKD PATIENTS often are advised to restrict their dietary intake of some nutrients to slow disease progression and prevent complications. Sodium intake should be limited to 2-2.4 g/day to reduce fluid accumulation and assist in blood pressure control, while phosphorus should be restricted to 800-1,000 mg/day to reduce renal osteodystrophy and calcification.

AMERICA'S obesity epidemic continues unabated and has spread to other places where the Western diet prevails. Every new health survey shows that heaviness and obesity continue to rise, especially in children and younger adults.

NEPHROLITHIASIS results from an interaction between diet and genetic predisposition. Most renal stones contain calcium oxalate, which is why controlling urinary calcium concentration is viewed as prophylactic.