A new review published in the New England Journal of Medicine highlights important areas in the nutritional management of chronic kidney disease (CKD).

As CKD advances, uremia, electrolyte and acid-base imbalances, water and salt retention, mineral and bone disorders ensue. Protein-energy wasting is also common. Yet review authors Kamyar Kalantar-Zadeh, MD, MPH, PhD, and Denis Fouque, MD, PhD, suggest that disease-specific dietary ranges may improve patient health. After reviewing current evidence, they recommended dietary and nutrient intakes, by CKD stage, of protein, sodium, potassium, phosphorus, calcium, fibers, energy, and fats.

For example, they recommend that protein intake should be less than 1.0 g/kg/day for patients with mild-to-moderate CKD, 0.6–0.8 g/kg/day for those with advanced CKD, and 1.2–1.4 g/kg/day for patients receiving ongoing dialysis. For individuals with normal kidney function who are at increased CKD risk, they recommend a protein intake of less than 1.0 g/kg/day with an increased proportion of protein from plant sources.

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“Given the high incidence and prevalence of chronic kidney disease and an urgent need for alternative disease management strategies, nutritional interventions with disease-specific dietary ranges that are patient-centered and cost-effective may help increase longevity and prolong the dialysis-free interval for millions of people worldwide,” the authors concluded.

Notably, the authors suggest a low-protein diet may slow disease progression and help CKD patients prevent or delay dialysis with minimal risks for protein-energy wasting and cachexia. Consuming more protein from plants than animal sources has been linked with better health. A low protein diet may lower intraglomerular pressure and proteinuria, in addition to reducing urea production.

Dr Kalantar-Zadeh and Dr Fouque recommend that clinicians monitor patients’ dietary protein, energy, and micronutrient intakes. In addition, clinicians should use 24-hour urine collections to gauge dietary protein consumption, sodium, and potassium, as well as measure creatinine clearance and proteinuria.

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Kalantar‑Zadeh K and Fouque D. Nutritional management of chronic kidney disease. N Engl J Med. 2017;377:1765-76. doi: 10.1056/NEJMra1700312