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CKD: Micronutrient: Executive Summary of Recommendations (2020)

CKD: Micronutrient: Executive Summary of Recommendations (2020)

Executive Summary of Recommendations 
Below are the recommendations and ratings for the Academy of Nutrition and Dietetics 2020 Chronic Kidney Disease (CKD) Micronutrient Evidence-Based Nutrition Practice Guideline. Use the links on the left to view the Guideline Introduction. Detailed recommendations, including the evidence supporting these recommendations, is available from the Major Recommendations tab.

  • For  a description of the Academy Recommendation Rating scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.
  • For a description of the GRADE Recommendation Rate scheme (Level 1 (1A, 1B, 1C, 1D), Level 2 (2A, 2B, 2C, 2D), click here

  • Nutrition Intervention
    CKD: Dietary Micronutrient Intake
    In adults with CKD 3-5D or posttransplantation, it is reasonable for the registered dietitian nutritionist (RDN) or an international equivalent, to encourage eating a diet that meets the recommended dietary allowance (RDA) for adequate intake for all vitamins and minerals (OPINION)
    Consensus
    Conditional
    CKD: Micronutrient Assessment and Supplementation
    In adults with CKD 3-5D or posttransplantation, it is reasonable for the registered dietitian nutritionist (RDN) or an international equivalent, in close collaboration with a physician or physician assistant, to assess dietary vitamin intake periodically and to consider multivitamin supplementation for individuals with inadequate vitamin intake (OPINION).
    Consensus
    Conditional
    CKD: Micronutrient Supplementation, Dialysis
    In adults with CKD 5D who exhibit inadequate dietary intake for sustained periods of time, it is reasonable to consider supplementation with multivitamins, including all the water-soluble vitamins, and essential trace elements to prevent or treat micronutrient deficiencies (OPINION).
    Consensus
    Conditional
    CKD: Folic Acid Supplementation for Hyperhomocysteinemia
    In adults with CKD 3-5D or posttransplantation who have hyperhomocysteinemia associated with kidney disease, we recommend not to routinely supplementing folate with or without B-complex since there is no evidence demonstrating reduction in adverse cardiovascular outcomes (1A).
    Strong
    Conditional
    CKD: Folic Acid Supplementation for Folic Acid Deficiency and Insufficiency, CKD 1-5 and Dialysis
    In adults with CKD 1-5D, we suggest prescribing folate, Vitamin B12 and/or B-complex supplement to correct for folate or Vitamin B12 deficiency/insufficiency, based on clinical signs and symptoms (B2). 
    Fair
    Conditional
    CKD: Folic Acid Supplementation for Folic Acid Deficiency and Insufficiency, CKD Post-Transplant
    In adults with CKD posttransplantation, we suggest prescribing folate, Vitamin B12 and/or B-complex supplement to correct for folate or Vitamin B12 deficiency/insufficiency based on clinical signs and symptoms (OPINION). 
    Consensus
    Conditional
    CKD: Vitamin C Supplementation
    In adults with CKD 1-5D or posttransplantation who are at risk of Vitamin C deficiency it is reasonable to consider supplementation to meet the recommended intake of at least 90 mg/d for men and 75 mg/d for women (OPINION).
    Consensus
    Conditional
    CKD: Vitamins E and A Supplementation and Toxicity
    In adults with CKD 5D on MHD or CKD 5D on PD, it is reasonable to not routinely supplement Vitamin A or E because of the potential for vitamin toxicity. However, if supplementation is warranted, care should be taken to avoid excessive doses, and patients should be monitored for toxicity (OPINION).
    Consensus
    Imperative
    CKD: Anticoagulant Medication and Vitamin K Supplementation
    In adults with CKD 1-5D or posttransplantation, it is reasonable that patients receiving anticoagulant medicines known to inhibit vitamin K activity (e.g., warfarin compounds) do not receive vitamin K supplements (OPINION).
    Consensus
    Conditional
    CKD: Selenium and Zinc Supplementation
    In adults with CKD 1-5D, we suggest to not routinely supplementing selenium or zinc since there is little evidence that it improves nutritional, inflammatory or micronutrient status (2C).
    Weak
    Imperative
    CKD: Vitamin D Supplementation for Vitamin D Deficiency and Insufficiency, CKD 1-5D
    In adults with CKD 1-5D (2C), we suggest prescribing Vitamin D supplementation in the form of cholecalciferol or ergocalciferol to correct 25(OH)D deficiency/insufficiency.
    Weak
    Conditional
    CKD: Vitamin D Supplementation for Vitamin D Deficiency and Insufficiency, CKD Post-Transplant
    In adults with CKD posttransplantation, we suggest prescribing Vitamin D supplementation in the form of cholecalciferol or ergocalciferol to correct 25(OH)D deficiency/insufficiency (OPINION).
    Consensus
    Conditional
    CKD: Vitamin D Supplementation with Proteinuria
    In adults with CKD 1-5 with nephrotic-range proteinuria, it is reasonable to consider supplementation of cholecalciferol, ergocalciferol or other safe and effective 25(OH)D precursors (OPINION).
    Consensus
    Conditional

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