The National Kidney Foundation (NKF), in collaboration with the Academy of Nutrition and Dietetics, released an updated nutrition guideline for patients with chronic kidney disease (CKD).

The guideline was developed as part of the NKF’s Kidney Disease Outcomes Quality Initiative (KDOQI). The 107-page guideline document, KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update, revises and expands the KDOQI guideline on nutrition for patients with end-stage kidney disease published in 2000. The update has been expanded to include nutritional management of patients with CKD stages 1 to 5 and patients with a functioning kidney transplant. An important thrust of the updated guideline is that “everybody who has kidney disease should have a nutritional assessment,” said Kerry Willis, PhD, chief scientific officer for NKF. The guideline emphasizes the role of the registered dietitian, usually in collaboration with a physician or other provider, in conducting nutritional assessments and providing medical nutrition therapy, she said.

“I hope that it will be a landmark in the field,” Dr Willis said of the new guideline.

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Guideline recommendations are organized to 6 primary topics: nutritional assessment, medical nutrition therapy, protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. “This grouping should make it easier for the practitioner to identify best standards of care in particular aspects of nutritional management of patients with CKD,” Alison Steiber, PhD, RDN, chief science officer for the Academy of Nutrition and Dietetics, and KDOQI chair Michael V. Rocco, MD, MSCE, wrote in a foreward to the guideline.

“The guidelines are organized according to the basic components of nutrition care,” Dr Willis said. “Practical clinical recommendations that are easy to find when you need them and straightforward to apply to patient care.”

The guideline, which took 5 years to develop and involved 2 comprehensive literature reviews that identified more than 15,000 studies for possible inclusion, reflects the many medical advances over the past 20 years that have improved understanding of how nutrition influences kidney disease as well as the general health of patients with CKD, Dr Willis said. She noted, for example, that the updated guideline includes a recommendation to prescribe a Mediterranean diet to all patients with CKD not on dialysis or after receiving a kidney transplant, with or without dyslipidemia, to improve lipid profiles and thereby lower patients’ risk of cardiovascular disease.

The international, multidisciplinary workgroup that developed the guideline was chaired by T. Alp Ikizler, MD, of Vanderbilt University Medical Center, Nashville, and Lillian Cuppari, PhD, of Oswaldo Ramos Foundation-Hrim Federal University of Sao Paulo, Brazil.

“Nutritional abnormalities are the hallmark of kidney disease and diet plays an important role in the day to day management of patients with CKD,” Dr Ikizler said in an NKF press release. “The updated guidelines reflect the significant improvements in the understanding and care of patients with CKD in terms of their metabolic and nutritional milieu. We are hopeful that our colleagues will embrace these guidelines and implement them into their practice in the most effective way to improve the lives of those with CKD.” 


Ikizler TA, Burrows JD, Byham-Gray LD, Campbell KL, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis. 2020;76(3S1):S1-S107. doi:10.1053/j.ajkd.2020.05.006