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Chronic Kidney Disease

CKD: Introduction (2010)

Guideline Title

Chronic Kidney Disease (2010) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on medical nutrition therapy (MNT) for adults with chronic kidney disease (CKD stages 1 - 5, including post kidney transplant) not on dialysis.

The primary goals of MNT are to prevent and treat protein-energy malnutrition, mineral and electrolyte disorders, and to minimize the impact of other comorbidities on the progression of kidney disease, e.g. diabetes, obesity, hypertension and disorders of lipid metabolism.

Guideline Development

This guideline is an update to the ADA 2001 Chronic Kidney Disease MNT Evidence-Based Guide for Practice and builds on the topic areas and recommendations that were made in the previous version.

This guideline is intended for use by Registered Dietitians (RDs) involved in providing MNT to adults with CKD. The application of the guideline must be individualized to assist the Registered Dietitian in successfully integrating MNT into the overall medical management of adults with CKD. The recommendations in the guideline were based on a systematic review of the literature and incorporate existing guidelines for KDOQI Clinical Practice Guidelines (accessed at http://www.kidney.org/Professionals/kdoqi/). These recommendations for chronic kidney disease are based on a combination of recent ADA evidence analysis and recommendations from the evidence-based guidelines developed by KDOQI. Kidney Disease: Improving Global Outcomes (KDIGO, accessed at www.kdigo.org) and other international guidelines will be reviewed for use in future updates.

The recommendations are based on the work performed by the American Dietetic Association CKD Expert Work Group. The number of supporting documents for these topics is below:

Recommendations: Twenty-four (24)
Conclusion Statements: Seventeen (17)
Evidence Summaries: Twenty-one (21)
Article Worksheets: One hundred and fifty-eight (158).

To learn about the Academy's systematic review methodology guideline development process, visit the Policy and Process section of the EAL

Application of the Guideline

This guideline will be accompanied by a set of companion documents to assist the practitioner in applying the guideline. A toolkit will contain materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the ADA's Dietetic Practice-Based Research Network prior to publication.

Revision

The literature search will be repeated for each guideline topic on an annual basis to identify new research that has been published since the previous search was completed. Based on the quantity and quality of new research, a determination will be made about whether the new information could change the published recommendation or rating.

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see Evidence Analysis Manual).

When the analysis is completed, the expert workgroup will approve and re-grade the conclusion statements and recommendations. The guideline will undergo a complete revision every three to five years.

Medical Nutrition Therapy and Chronic Kidney Disease

Scientific evidence supports the effectiveness of medical nutrition therapy to increase effectiveness of therapy for chronic kidney disease, including post kidney transplant. Topics included in this guideline are:

Medical nutrition therapy and dietitian intervention
Energy needs
Protein needs
CKD-bone mineral disorder
Anemia
Diabetes
Obesity
Hypertension
Disorders of lipid metabolism
Physical activity
Fish oil therapy

The Registered Dietitian plays an integral role on the interdisciplinary care team by determining the optimal nutrition prescription and developing the nutrition care plan for patients undergoing therapy for chronic kidney disease. Based on the patient’s treatment plan and comorbid conditions, other nutrition practice guidelines, such as critical care guidelines, may be needed in order to provide optimal treatment.

Populations to Whom This Guideline May Apply

This guideline applies to adults with chronic kidney disease (CKD stages 1 - 5, including post kidney transplant) not on dialysis.

Other Guideline Overview Material

For more details on the guideline components, use the links on the left to access:

Scope of Guideline
Statement of Intent
Guideline Methods
Implementation of the Guideline
Benefits and Harms of Implementing the Recommendations

Contraindications

Clinical judgment is crucial in the application of these guidelines. Careful consideration should be given to the application of these guidelines for patients with significant medical co-morbidities.