CKD: Electrolytes and Other Nutrients: Executive Summary of Recommendations (2020)

CKD: Electrolytes and Other Nutrients: 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) Electrolyte and Other Nutrients 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 Phosphorus Amount
    In adults with CKD 3-5D, we recommend adjusting dietary phosphorus intake to maintain serum phosphate levels in the normal range (1B).
    Strong
    Imperative
    CKD: Dietary Phosphorus Source
    In adults with CKD 1-5D or posttransplantation, it is reasonable when making decisions about phosphorus restriction treatment to consider the bioavailability of phosphorus sources (e.g. animal, vegetable, additives) (OPINION).
    Consensus
    Conditional
    CKD: Phosphorus Intake with Hypophosphatemia
    For posttransplantation adults with hypophosphatemia, it is reasonable to consider prescribing high-phosphorus intake (diet or supplements) in order to replete serum phosphate (OPINION).
    Consensus
    Conditional
    CKD: Sodium Intake and Blood Pressure, CKD 3-5, Non-Dialyzed
    In adults with CKD 3-5 not on dialysis, we recommend limiting sodium intake to less than 100 mmol/day (or <2.3 g/day) to reduce blood pressure and improve volume control (1B).
    Strong
    Imperative
    CKD: Sodium Intake and Blood Pressure, CKD 5D and Post-Transplant
    In adults with CKD 5D or posttransplantation, we recommend limiting sodium intake to less than 100 mmol/day (or <2.3 g/day) to reduce blood pressure and improve volume control (1C).
    Fair
    Imperative
    CKD: Sodium Intake and Proteinuria
    In adults with CKD 3-5, we suggest limiting sodium intake to less than 100 mmol/day (or <2.3 g/day) to reduce proteinuria synergistically with available pharmacological intervention (2A).
    Fair
    Conditional
    CKD: Sodium Intake and Dry Body Weight
    In adults with CKD 3-5D, we suggest reduced dietary sodium intake as an adjunctive lifestyle modification strategy to achieve better volume control and a more desirable body weight (2B).
    Fair
    Conditional
    CKD: Dietary Potassium Amount
    In adults with CKD 3-5D or posttransplantation, it is reasonable to adjust dietary potassium intake to maintain serum potassium within the normal range (OPINION).
    Consensus
    Conditional
    CKD: Dietary and Supplemental Potassium Intake for Hyperkalemia or Hypokalemia, CKD Post-Transplant
    In adults with CKD posttransplantation with either hyperkalemia or hypokalemia, we suggest that dietary or supplemental potassium intake be based on patient's individual needs and clinician judgement (OPINION). 
    Consensus
    Conditional
    CKD: Dietary and Supplemental Potassium Intake for Hyperkalemia or Hypokalemia, CKD 3-5D
    In adults with CKD 3-5D with either hyperkalemia or hypokalemia, we suggest that dietary or supplemental potassium intake be based on a patient’s individual needs and clinician judgment (2D).
    Weak
    Imperative
    CKD: Dietary Management of Net Acid Production (NEAP)
    In adults with CKD 1-4, we suggest reducing net acid production (NEAP) through increased dietary intake of fruits and vegetables (2C) in order to reduce the rate of decline of residual kidney function.
    Weak
    Conditional
    CKD: Bicarbonate Supplementation
    In adults with CKD 3-5D, we recommend reducing net acid production (NEAP) through increased bicarbonate or a citric acid/sodium citrate solution supplementation (1C) in order to reduce the rate of decline of residual kidney function.
    Fair
    Conditional
    CKD: Bicarbonate Maintenance
    In adults with CKD 3-5D, it is reasonable to maintain serum bicarbonate levels at 24-26 mmol/L (OPINION).
    Consensus
    Conditional
    CKD: Total Calcium Intake, CKD 3-4
    In adults with CKD 3-4 not taking active Vitamin D analogs, we suggest that a total elemental calcium intake of 800-1,000 mg/d (including dietary calcium, calcium supplementation and calcium-based phosphate binders) be prescribed to maintain a neutral calcium balance (2B).
    Fair
    Conditional
    CKD: Total Calcium Intake, CKD 5D
    In adults with CKD 5D,  it is reasonable to adjust calcium intake (dietary calcium, calcium supplements or calcium-based binders) with consideration of concurrent use of vitamin D analogs and calcimimetics in order to avoid hypercalcemia or calcium overload (OPINION).
    Consensus
    Conditional

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