Nutrition Intervention
CKD: Dietary Patterns: Mediterranean Diet
In adults with CKD 1-5 not on dialysis or posttransplantation, with or without dyslipidemia, we suggest that prescribing a Mediterranean Diet may improve lipid profiles (2C).
CKD: Dietary Patterns: Fruits and Vegetables
In adults with CKD 1-4, we suggest that prescribing increased fruit and vegetable intake may decrease body weight, blood pressure and net acid production (NEAP) (2C).
CKD: LC n-3 PUFA Nutritional Supplements for Lipid Profile, Maintenance Hemodialysis
In adults with CKD 5D on MHD, we suggest that 1.3-4 g/d LC n-3 PUFA may be prescribed to reduce triglycerides and LDL cholesterol (2C) and raise HDL levels (2D).
CKD: LC n-3 PUFA Nutritional Supplements for Lipid Profile, Peritoneal Dialysis
In adults with CKD 5D on PD, it is reasonable to consider prescribing 1.3-4 g/d LC n-3 PUFA to improve the lipid profile (OPINION).
CKD: LC n-3 PUFA Nutritional Supplements for Lipid Profile, Non-dialyzed
In adults with CKD 3-5, we suggest prescribing ~2g/d LC n-3 PUFA to lower serum triglyceride levels (2C).
CKD: LC n-3 PUFA Nutritional Supplements for Mortality and Cardiovascular Disease, Maintenance Hemodialysis and Post-Transplant
In adults with CKD 5D on MHD or posttransplantation, we suggest not routinely prescribing LC n-3 PUFA, including those derived from fish or flaxseed and other oils, to lower risk of mortality (2C) or cardiovascular events (2B).
CKD: LC n-3 PUFA Nutritional Supplements for Mortality and Cardiovascular Disease, Peritoneal Dialysis
In adults with CKD 5D on PD, it is reasonable to not routinely prescribe LC n-3 PUFA, including those derived from fish or flaxseed and other oils, to lower risk of mortality or cardiovascular events (OPINION).
CKD: Protein Restriction, Non-Dialysis, Non-Diabetic
In adults with CKD 3-5 who are metabolically stable, we recommend, under close clinical supervision, protein restriction with or without keto acid analogs, to reduce risk for ESKD/death (1A) and improve quality of life (2C).
- a low protein diet providing 0.55 to 0.60 g dietary protein/kg body weight/day , OR
- a very-low protein diet providing 0.28 to 0.43 g dietary protein/kg body weight/day with additional keto acid/amino acid analogs to meet protein requirements (0.55 to 0.60 g /kg body weight/day)
CKD: Dietary Protein Intake, Maintenance Hemodialysis, Non-Diabetic
In adults with CKD 5D on MHD (1C) who are metabolically stable, we recommend prescribing a dietary protein intake of 1.0 -1.2 g /kg body weight per day to maintain a stable nutritional status.
CKD: Dietary Protein Intake, Peritoneal Dialysis, Non-Diabetic
In adults with CKD 5D on PD (OPINION) who are metabolically stable, we recommend prescribing a dietary protein intake of 1.0 -1.2 g /kg body weight per day to maintain a stable nutritional status.
CKD: Macronutrients: Protein Type
In adults with CKD 1-5D, there is insufficient evidence to recommend a particular protein type (plant vs animal) in terms of the effects on nutritional status, calcium or phosphorus levels, or the blood lipid profile (1B).
CKD: Macronutrients: Protein Type, Post-Transplant
In adults with CKD posttransplantation, there is insufficient evidence to recommend a particular protein type (plant vs animal) in terms of the effects on nutritional status, calcium or phosphorus levels, or the blood lipid profile (OPINION).
CKD: LC n-3 PUFA Nutritional Supplements for AV Graft and Fistula Patency for Maintenance Hemodialysis
In adults with CKD 5D on maintance himodialysis (MHD), we suggest not routinely prescribing fish oil to improve primary patency rates in patients with AV grafts (2B) or fistulas (2A).
CKD: LC n-3 PUFA Nutritional Supplements for Kidney Allograft Survival
In posttransplantation adults, we suggest not routinely prescribing LC n-3 PUFA to reduce the number of rejection episodes or improve graft survival (2D).
CKD: Oral Protein-Energy Supplementation for CKD 3-5D
In adults with CKD 3-5D at risk of or with protein-energy wasting, we suggest a minimum of a 3-month trial of oral nutritional supplements to improve nutritional status if dietary counselling alone does not achieve sufficient energy and protein intake to meet nutritional requirements (2D).
CKD: Oral Protein-Energy Supplementation for Post-Transplant
In adults with CKD posttransplantation at risk of or with protein-energy wasting, it is reasonable to consider a minimum of a 3-month trial of oral nutritional supplements to improve nutritional status if dietary counselling alone does not achieve sufficient energy and protein intake to meet nutritional requirements (OPINION).
CKD: Enteral Nutrition Supplementation
In adults with CKD 1-5D, with chronically inadequate intake and whose protein and energy requirements cannot be attained by dietary counselling and oral nutritional supplements, it is reasonable to consider a trial of enteral tube feeding (OPINION).
CKD: Total Parenteral Nutrition (TPN) and Intradialytic Parenteral Nutrition (IDPN) Protein-Energy Supplementation
In adults with CKD with protein-energy wasting, we suggest a trial of total parenteral nutrition (TPN) for CKD 1-5 patients and IDPN for CKD 5D on MHD patients, to improve and maintain nutritional status if nutritional requirements cannot be met with existing oral and enteral intake (2C).
CKD: Dialysate Protein-Energy Supplementation
In adults with CKD 5D on PD with protein-energy wasting, we suggest not substituting conventional dextrose dialysate with amino acid dialysate as a general strategy to improve nutritional status, although it is reasonable to consider a trial of amino acid dialysate to improve and maintain nutritional status if nutritional requirements cannot be met with existing oral and enteral intake (OPINION).
CKD: Protein Restriction, Non-Dialysis, Diabetic
In adults with CKD 3-5 and who have diabetes, it is reasonable to prescribe, under close supervision, a dietary protein intake of 0.6–0.8 g /kg body weight per day to maintain a stable nutritional status and optimize glycemic control (OPINION).
CKD: Dietary Protein Intake, Maintenance Hemodialysis and Peritoneal Dialysis, Diabetic
In adults with CKD 5D and who have diabetes, it is reasonable to prescribe a dietary protein intake of 1.0 -1.2 g /kg body weight per day to maintain a stable nutritional status. For patients at risk of hyper and/or hypoglycemia, higher levels of dietary protein intake may need to be considered to maintain glycemic control (OPINION).
CKD: Statement on Energy Intake in CKD 1-5D
In adults with CKD 1-5D (1C) and who are metabolically stable, we recommend prescribing an energy intake of 25-35 kcal/kg body weight per day based on age, gender, level of physical activity, body composition, weight status goals, CKD stage, and concurrent illness or presence of inflammation to maintain normal nutritional status.
CKD: Statement on Energy Intake in Post-Transplant
In adults with CKD posttransplantation (OPINION) who are metabolically stable, we recommend prescribing an energy intake of 25-35 kcal/kg body weight per day based on age, gender, level of physical activity, body composition, weight status goals, CKD stage, and concurrent illness or presence of inflammation to maintain normal nutritional status.
