Nutritional Management of

Chronic Kidney Disease

Cheyenne Tate
Renal Rotation
Janelle Fraley MS, RD, CSR, LD
Metabolic Changes

Protein
catabolism
Altered protein
and energy
homeostasis •May distort
taste/smell/appetite

Altered GI Muscle and fat

absorption wasting

•Uremia •Comorbid conditions

microbiome exacerbate
disruption
Overview of Limitations for CKD

Phosphorus Sodium Protein Potassium

 Low protein constricts glomerular
arterioles lower pressure
 High protein dilates arterioles
increasing filtration

 Over time hyperfiltration may

damage remaining glomeruli
 Common Recommendations: Protein

Low protein diet lessens proteinuria

Less urea generation
Consistently high blood urea= higher oxidative stress = CVD risk
Recommendation usually 0.6-0.8g/kg

EXTREMELY LOW PROTEIN DIET:

• <0.6g/kg + supplementation of essential

AA or their ketoacids
Sodium

Rationale: control fluid retention, HTN, improve CVD risk profile

The data?
• Inconsistent
• J Curve
• Increased risk of CVD at >5g and <3g

Recommendation:
<4g for management of CKD
<3g for management of fluid retention or proteinuria
 Potassium

Moderately low and high levels of

potassium are associated with CKD
Unhealthy
progression options,
pro CVD

Lower potassium usually recommended:

<3gm/day Increased
CKD
• CVD risk progression
• Constipation
 Phosphorus

High plasma phosphorus has been associated with increased kidney disease in healthy
individuals

Recommendation: <800mg

Why we care in CKD: hyperphosphatemia

• High PTH can cause renal bone disease
• Left ventricular hypertrophy
• Vascular calcification
• Overall accelerated decline
Calcium and Vitamin D

 Recommend 800-1000mg elemental Ca/day, Vit D supplement

 CKD declined Vit D less GI absorption of Calcium
 Body releases Ca from bones
 Change in cell performance
 Bone quality declines, vascular tissue quality declines
Calciphylaxis
Trace Elements and Vitamins

Inadequate food intake  low antioxidant intake

 Vitamin C, E, carotenoids
More advanced CKD Folate, vitamin K, and calcitriol become deficient
 Micronutrient imbalance  oxidative stress, inflammation, CVD

Iron deficiency most problematic

 GI blood loss
Misc. Diets

 Vegetarian:
 No evidence that plant based or animal based protein diet makes a
difference in acquiring CKD
 However: plant based protein> fiber, less constipation, less
saturated fats, less absorbable phosphorus, less acid
 CKD diets higher in plant based protein associated with better outcomes
Source

 Nutritional Management of Chronic Kidney Disease, Kamyar Kalantar-Zadeh, M.D., M.P.H.,

Ph.D., and Denis Fouque, M.D., Ph.D., N Engl J Med 2017; 377:1765-1776. November 2, 2017
DOI: 10.1056/NEJMra1700312