Chronic Kidney Disease

Chronic Kidney Disease

Welcome to the Chronic Kidney Disease (CKD) Guideline and Systematic Review

The focus of the 2020 Chronic Kidney Disease (CKD) Guideline is on the treatment of adults with kidney disease. Nutrition and its management is an integral part of the care of patients with kidney disease. Due to the most recent advances in evidence, the Academy of Nutrition and Dietetics and the National Kidney Foundation collaborated to merge, update and expand the 2010 Evidence Analysis Library® (EAL®) CKD project and the Kidney Disease Outcomes Quality Initiative (KDOQI) Nutrition Guidelines.

About the CKD Guideline

The overall objective of the 2020 CKD Guideline  is to provide medical nutrition therapy (MNT) guidelines for patients with kidney disease to assess, prevent and treat protein-energy wasting, mineral and electrolyte disorders, and other metabolic disorders that are associated with kidney disease. The target population is adults with chronic kidney disease: Stages 1-5, including dialysis and post-kidney transplant. The expert workgroup was divided into three groups and each group concentrated their efforts on the following subtopics:

  • Macronutrients
  • Micronutrients
  • Electrolytes
  • Assessment: Nutritional Status, Dietary Intake, Energy Requirements
  • Medical Nutrition Therapy
  • Dietary Patterns

A total of 83 recommendations were developed with the following major categories of outcomes:

  • Hard outcomes: mortality, RRT, quality of life, hospitalization
  • Nutritional status outcomes: SGA, PWS, protein markers
  • Dietary intake outcomes: FFQ, 24-hour recall, diet history
  • Inflammation outcomes: CRP, adipokines, cytokines
  • Anthropometrics: body weight, BMI, waist circumference, skinfold thickness, conicity index
  • Electrolyte biomarkers: serum or urinary excretion for all included micronutrients
  • CKD progression: eGFR, creatinine
  • Comorbidity outcomes: lipid profile, blood pressure

Download the CKD Guideline Comparison Table to see the changes between the 2010 and 2020 guideline. SInce not all of the 2010 recommendations were reviewed or updated, the guideline and systematic review remain as an accessible resource.

  • Use the left navigation bar to view the CKD guideline and supporting systematic reviews.
  • Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project. disclosures and project funding information.
  • Expand the section below titled CKD Guideline Resources and Article for resources to assist with implementation and dissemination of the 2020 CKD guideline and publications from this project.

 

Updated: 11/11/2020

  • Project Team and Disclosures (2020)

    The following individuals contributed their valuable time and expertise on this project:

    Workgroup Members

    • Talat Alp Ikizler, MD, Co-Chair
      Catherine McLaughlin-Hakim Chair in Vascular Biology; Professor Medicine Vanderbilt University, Nashville, TN, USA
    • Lilian Cuppari, PhD, Co-Chair
      Oswaldo Ramos Foundation-Hrim, Federal University of São Paulo, São Paulo, Brazil
    • Jerrilynn D. Burrowes, PhD, RD, CDN
      Professor, Department of Nutrition, Long Island University, Brookville, NY, USA
    • Laura D. Byham-Gray, PhD, RD, FNKF
      Professor and Vice Chair of Research, Rutgers University, Newark, NJ USA
    • Katrina Louise Campbell, PhD AdvAPD
      Associate Professor, Bond University, Robina, Queensland, Australia
    • Juan Jesus Carrero, Pharm, PhD Pharm, PhD, Med MBA
      Professor of Renal Epidemiology, Karolinska University Hospital, Stockholm Sweden
    • Winnie Chan, PhD, RDN
      Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
    • Denis Fouque, MD, PhD
      Professor of Nephrology, Université de Lyon, Lyon, France
    • Allon Nir Friedman, MD, FASN
      Associate Professor of Medicine, Indiana University School of Medicine, Indianapolis, IN  USA
    • Sana Ghaddar, PhD, RDN
      Renal Dietitian, Davita Healthcare Partners, Fremont, CA, USA
    • D. Jordi Goldstein, DSc, APN, NP-C, RD
      Nephrology Nurse Practitioner, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
    • George Alan Kaysen, MD, PhD
      Professor Emeritus Internal Medicine and Biochemistry and Molecular Medicine, University of California-Davis School of Medicine, Davis, CA, USA
    • Joel Kopple, MD
      University of California-Los Angeles Medical Center, Torrance, CA, USA
    • Daniel Teta, MD, PhD
      Professor, Lausanne University / Chief of Service, Hospital du Valais, Sion, Switzerland
    • Angela Yee-Moon Wang, MB BS, MD, PhD,, FRCP, FHKCP, FHKAM, FASN
      University of Hong Kong, Hong Kong
       

    Evidence Analyst

    • Megan Baumer PhD, RD
      Professor, Mount Mary University, Milwaukee, WI, USA
    • Alison G. M. Brown, PhD, RD
      Boston Food Policy Council Member, Boston, MA, USA
    • Margaret Chenault, MS
      Project Manager/Coordinator, Drexel University, Philadelphia, PA, USA
    • Alanna M. Clark, MPH
      Public Health Nutritionist (WIC), Mecklenburg County, Carolinas Healthcare Systems, Charlotte, NC, USA
    • Lisa A. Davis, MS, RD
      Clinical Dietitian, University of Wisconsin Hospital & Clinics, Madison, WI, USA
    • Sharon Foley, PhD, RDN
      Assistant Professor, Rush University, Chicago, IL, USA
    • Anne O. Garceau, MS, RDN
      Nutritionist, USDA, Beltsville, MD, USA
    • Erica K. Gradwell, MS, RD
      Consultant, Arvada, CO, USA
    • Keli Hawthorne, MS, RDN
      Director of Clinical Research, University of Texas at Austin Dell Medical School, Austin, TX, USA
    • Yi-Hsuan Liu, MS
      Graduate Research Assistant, The Pennsylvania State University, State College, PA, USA
    • Courtney T. Luecking, MPH, MS, RDN
      Doctoral Candidate, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    • Haiyan Maier, PhD, RD
      Florida State University, Tallahassee, FL, USA
    • Christiane Lumachi Meireles, PhD, RDN, LD
      Clinical Assistant Professor, University of Texas Health, San Antonio, TX, USA
    • Melanie M. Mott, PhD, RD
      Clinical Writer, Ipswich, MA, USA
    • Keiy C. Murofushi, MS, RDN
      Executive Director, Food and Nutrition, Cedars-Sinai Medical Center, Los Angeles, CA, USA
    • Joan Pleuss, MS, RDN
      Retired, Milwaukee, WI, USA
    • Krisa Shawron, MS, RD, LDN
      Clinical Research Coordinator, Rush University Medical Center, Chicago, IL USA
    • Helen D. Solomon, MBA, RD
      Retired, Wildwood, MO, USA
    • Terrance Vance, PhD, MS, RDN
      Assistant Professor, Dept. of Nutrition, SUNY College of Plattsburgh, Plattsburgh, NY
    • Amy Yahiro, MS, RD, LDN
      Manager, Evidence-Based Medicine, North American Spine Society, Burr Ridge, IL, USA
    • Jinyu Xu, PhD, MPH, RD
      Research Scientist, Nationwide Children’s Hospital, Columbus, OH, USA
       

    Guideline Reviewers

    • Jungoak Choe, PhD, RDN, CSR
      Renal Dietitian, DaVita Kidney Care, Fairfax, VA, USA
    • Laura Koch, MS, RDN
      Renal Dietitian, Dialysis Center of Lincoln, Inc., Lincoln, NE, USA
    • Tabbetha D. Lopez, RDN, PhD candidate
      Teaching Assistant, University of Houston, Houston, TX, USA
    • Lesley L. McPhatter, MS, RDN, CSR
      CNM - Renal Nutrition, Morrison Healthcare/University of Virginia Health System, Madison Heights, VA, USA
    • Nicole Moore, MS, RDN-APA
      Assistant Professor, Augusta Univesity, Augusta, GA, USA
    • Jessie Pavlinac, MS, RDN
      Manager, Clinical Nutrition, Oregon Health & Science University, Oregon City, OR, USA
    • Jeanette M. Sheppard, MA, RDN
      Dietitian, Fresenius Medical Care, Alamogordo, NM, USA
    • Katherine Welland, RDN
      Renal Dietitian, Fresenius Kidney Care, Chicago, IL, USA
    • Aisling Whelan, MS, RDN
      Renal Dietitian, Island Rehabilitative Service, New York, NY, USA
    • The guideline was reviewed internally by KDOQI leadership, the NKF Scientific Advisory Board and externally by content experts from ISRNM.
       

    Academy of Nutrition and DIetetics Evidence Analysis Center Staff

    • Deepa Handu, PhD, RDN, LDN, Project Manager and Methodologist
    • Mary R. Rozga, PhD, RDN, Lead Analyst
    • Alison Stieber, PhD, RDN
    • Feon Cheng, PhD, MPH, RDN, CHTS-CP
    • Lisa Moloney, MS, RDN
       

    National Kidney Foundation / KDOQI Staff

    • Kerry Willis, PhD
    • Laura Brereton, MSc
    • Jessica Joseph, MBA
    • Thomas Manley, RN, BSN, CRNA
       

    FInancial Contributors

    • Systematic Reviews
      • Academy of Nutrition and Dietetics
      • Academy of Nutrition and Dietetics Renal Dietitians DPG
    • Guideline
      • Academy of Nutrition and Dietetics
      • National Kidney Foundation
         

    Disclosures of Potential Conflicts of Interest

    In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Byham-Gray: Received compensation for consultant work from Abbott Nutrition and Nestle Nutrition; received fundin for a grant from NIDDK; received compensation from Abbott Nutrition and Nestle Nutrition for speaking/presentations; received compensation from Springer Publications for the Academy of Nutrition and Dietetics to author a publication 
    • Campbell: Received compensation for consultant work from Nestle Health Sciences
    • Carrero: Received funding for research grants from AstraZeneca and Relypsa on clinical epidemiological analyses on hyperkalemia in healthcare; consultant for AstraZeneca for an observational project on hyperkalemia in healthcare; received compensation from the International Society of Renal Nutrition and Metabolism for development of education presentations.
    • Fouque: Received compensation for serving on board of Fresenius Kabi; consultant for Sanofi Kabi Medice Astellas; received compensation for expert testimony from Sanofi; received compensation by Sanofi; Fresenius Kabi, Vifor for speaking/presentations; received reimbursement for meeting/travel expenses from Sanofi, Fresenius Kabi, Astellas, BBraun, Medice.
    • Ghaddar: Received compensation from ISRNM for speaking engagements; 
    • Ikizler: Received compensation for consultant work f rom Fresenius Kabi, Int, Abbott Renal Care, International Society of Nephrology, Satellitehealth, American Board of Internal Medicine, Baxter Renal Care, DSI Inc., Merck; Nestle, Reata, Prometic, Relypsa, Axcella
    • Kaysen: Received grant funding from National Institute of Health Nutrition Special Study Active/Adipose; compensation for consultant work on NIDDK DSMB; 

     

    updated: 5/10/2019

  • Project Team and Disclosures (2010)

    The following individuals contributed their valuable time and expertise to this project:

    Expert Workgroup

    • Jessie Pavlinac, MS, RD, CSR, LD, Chair
    • Arianna Aoun, MS, RD, CSR, LD
    • Laura Byham-Gray, PhD, RD
    • Carolyn C. Cochran, MS, RD, LD, CDE
    • Barbara A. Hutson, RD, LD
    • Joni Pagenkemper, MS, MA, RD, LMNT, CDE

    Former Workgroup Members

    • Pamela S. Kent, MS, RD, CSR, LD
    • Jinette S. Lichter, RD, LMNT
    • Cathi J. Martin, RD, CSR, LDN

    Project Manager

    • Mei Chung, PhD, MPH

    Lead Evidence Analyst

    • Erica K. Gradwell, MS, RDN

    Evidence Analysts

    • Carly D. Gustafson, MS, RD, CD, LDN
    • Haewook Han, PhD, RD, LDN
    • Jodi A. Kingley, MS, RD, CNSD
    • Francoise Knox Kazimierczuk, MS, RD
    • Linda Massey, PhD, RD
    • Christiane Meireles, PhD, RD, LD
    • Carmen Tatum, MS, RD, CSP
    • Elisa Trigalo, RD, MS
    • Lee S. Wallace, MS, RD, FADA
    • Madelyn L. Wheeler, MS, RD, FADA

    Guideline Reviewers

    • Karen Basinger, RD
    • Debbie Benner, MA, RD, CSR
    • Jerrilyn Burrowes, PhD, RD, CDN
    • Louise Clement, MS,RD, CSR, LD
    • Charles J.Foulks, MD,FACP,FACN
    • Kathy Schiro Harvey, MS, RD, CSR
    • Maria Karalis, MBA, RD, LDN
    • Pamela S.Kent, MS, RD, CSR, LD
    • Elizabeth Kern, MD, MS
    • Nadiya Lakhani, RD, LD
    • Maureen McCarthy, MPH, RD,CSR, LD
    • Sharon R. Schatz, MS, RD, CSR, CDE

    Academy Staff

    • Deborah Cummins, PhD
    • Kari Kren, MPH, RD
    • Joan Schwaba, MS, RD, LDN
    • Esther F. Myers, PhD, RD

     

    Financial Contributors

    • Academy of Nutrition and Dietetics


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • None of the workgroup members listed above disclosed potential conflicts.
  • CKD Guideline Resources and Articles (2020)

    The following resources were developed for implementation and dissemination of the 2020 CKD Guideline:

    • Four-Part Webinar Series: Nutrition in Chronic Kidney Disease Guideline: The National Kidney Foundation and the Academy have collaborated on development of a multidisciplinary webinar series that highlights the 2020 CKD Guideline. Academy members can receive access to these webinars at the NKF member price by entering the code Nutrition2020 at checkout.  Learn more ...
    • EAL Chronic Kidney Disease Guideline Presentation (PPT): A 114-slide PowerPoint presentation includes the recommendations and ratings for the 2020 CKD Guideline. The guideline is a collaboration between the Academy and the National Kidney Foundation. Ideal for meetings, in-service presentations and classes. This product is not designed for the consumer. Learn more ...  
    • Executive Summary of the 2020 Academy of Nutrition and Dietetics and National Kidney Foundation Clinical Practice Guideline for Nutrition in 2020. The 2020 update to KDOQI Clinical Practice Guidelines for Nutrition in chronic kidney disease (CKD) is a result of the collaboration between the National Kidney Foundation (NKF) and the Academy of Nutrition and Dietetics (Academy). The target population for this guideline is adults with stages 1 through 5 CKD who are not receiving dialysis, end-stage kidney disease including those on dialysis, and individuals with functional kidney transplant. The updated guideline includes 83 recommendations on important nutrition topics in CKD, including nutrition screening and assessment; medical nutrition therapy; dietary protein and energy intake; micronutrients; electrolytes; nutritional supplementation; and dietary patterns. Both Academy and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches were used to assess quality of evidence and rate the recommendation statements. Guideline recommendations were the result of a comprehensive systematic review, clinical expertise, and considerations for individualized care. J Acad Nutr Diet. 2020  
    • KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the first KDOQI nutrition guideline, there has been a great accumulation of new evidence regarding the management of nutritional aspects of kidney disease and sophistication in the guidelines process. The 2020 update to the KDOQI Clinical Practice Guideline for Nutrition in CKD was developed as a joint effort with the Academy of Nutrition and Dietetics (Academy). It provides comprehensive up-to-date information on the understanding and care of patients with chronic kidney disease (CKD), especially in terms of their metabolic and nutritional milieu for the practicing clinician and allied health care workers. The guideline was expanded to include not only patients with end-stage kidney disease or advanced CKD, but also patients with stages 1-5 CKD who are not receiving dialysis and patients with a functional kidney transplant. The updated guideline statements focus on 6 primary areas: nutritional assessment, medical nutrition therapy (MNT), dietary protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. The guidelines primarily cover dietary management rather than all possible nutritional interventions. The evidence data and guideline statements were evaluated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research. AJKD 2020 Sept 76 (3):S1-S107.