CKD: Guideline Overview (2020)
Chronic Kidney Disease (2020) Evidence-Based Nutrition Practice Guideline
Guideline Narrative Overview
The focus of this guideline is on treatment and management of adults with chronic kidney disease (CKD) Stages 1-5 (non-dialyzed), those on dialysis, and including post-kidney transplantation. The objective is to provide medical nutrition therapy (MNT) 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 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 diseases.
This guideline is a collaborative initiative between the Academy of Nutrition and Dietetics (Academy) and the National Kidney Foundation (NKF) to update the Academy’s 2010 Chronic Kidney Disease guideline and NKF’s 2000 KDOQI Nutrition guidelines for CKD. This guideline is a comprehensive coverage on Assessment and Intervention topic areas in this field.
The guideline is intended for use by clinicians who work in the renal nutrition field, Registered Dietitian Nutritionists (RDNs), and nephrologists who are involved in providing nutrition care to adults with CKD. The application of the guideline must be individualized to assist the RDN in successfully integrating MNT into the overall medical management of adults with CKD. The recommendations in this guideline were based on comprehensive systematic reviews of the current literature. This guideline did not cover bone health as this topic was recently updated and published by the KDIGO group (Kidney Disease: Improving Global Outcomes), accessed at https://kdigo.org/wp-content/uploads/2017/02/2017-KDIGO-CKD-MBD-GL-Update.pdf.
Topics included in this guideline are:
- Assessment (dietary intake, nutritional stattus, lab measurements, body composition, etc)
- Dietary Protein Intake
- Energy Needs
- Dietary Patterns
- Nutritonal Supplements (oral, entereal, parenteral, dialysate, omega-3)
The recommendations are based on the work performed by the Academy's and NKF's expert work group and the evidence review team. The number of documents for these topics is:
- Recommendatitons: 83
- Conclusion Statements: 239
- Evidence Summaries: 34
- Article Worksheets: 350
To learn about the Academy's systematic review methodology guideline development process, visit the Policy and Procedures section of the Evidence Analysis Library (EAL).
Expand the section titled Project Team and Disclosures to see the list of individuals who developed this guideline.
Academy guidelines are revisited every five years. An expert workgroup will be convened by the Workgroup Selection subcommittee of the Council of Research (COR) to determine the need for new and revised recommendations based on the available science. The process includes:
- Scoping review to identify new research published since the previous searches were completed. Updated inclusion/exclusion criteria and search terms may be warranted.
- Review to determine if the update will include modification at all, some or no recommendations compared to the earlier version of the guidelines, or development of new recommendations.
- Creation of a table comparing the new guideline and the older version of the guideline. The document will indicate which recommendations remained unchanged; updated; new; or not reviewed.
Medical Nutrition Therapy and Chronic Kidney Disease
Scientific evidence supports the effectiveness of MNT to increase effectiveness of therapy for CKD, including post-transplant. The RDN is an integral part of the interdisciplinary care team and helps determine the optimal nutrition prescription and nutrition care plan for patients with CKD in order to provide optimal treatment.
Population to Whom This Guideline May Apply
This guideline applies to adults with CDK Stages 1-5, those on dialysis, and post-kidney transplants.
Other Guideline Overview Material
For more details on the guideline components, use the links on the left to access:
- Scope of the Guideline
- Statement of Intent
- Guideline Methods
- Dissemination and Implementation of the Guideline
- Benefits and Harms of Implementing the Recommendations
Clinical judgement is crucial in the application of these recommendatitons. Please work with your patients and pay careful consideration when applying these recommendations to pataients with significant co-morbidities.
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