Dietary management in kidney disease
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Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece
Publication date: 2022-05-27
Public Health Toxicol 2022;2(Supplement Supplement 1):A80
It has been almost 20 years since the first nutrition guidelines for patients with end-stage renal disease were published. The Kidney Disease Outcomes Quality Initiative (KDOQI) was a cornerstone that changed dramatically the nutritional management of CKD patients. In 2020 the KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update was published, joined with the Academy of Nutrition and Dietetics. The recent guidelines focus not only in patients on renal replacement but to the CKD stages 1-5 including those on transplantation.
Apart from the KDOQI 2020 nutritional guidelines, the medical teams dealing with CKD patients will also have relevant guidelines on hospitalized patients, published in 2021 by the European Society of Clinical Nutrition and Metabolism (ESPEN). These guidelines are a useful tool for clinicians and clinical dietitians for the management of patients with Acute Kidney Injury (AKI), patients with CKD in the acute care the overall nutritional support during hospital stay.
Having these guidelines available, undoubtedly the nutritional assessment, management, and the provision of nutritional support of patients with CKD is based on evidence-based data. Nonetheless, there are some aspects that need extra attention, in terms of dietary manipulation and availability of the methods and procedures proposed in clinical practice. The plant-based diets, the very low protein diets, the maintenance of dietary fiber intake alongside with the necessity of potassium control are issues that need to be stressed out and emphasized. Moreover, evidence on the provision of nutritional support on patients with AKI and CKD during hospitalization is of great importance, especially for the clinicians and dietitians working in hospitals.
Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020;76(3 Suppl 1):S1-S107. doi:10.1053/j.ajkd.2020.05.006
Fiaccadori E, Sabatino A, Barazzoni R, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021;40(4):1644-1668. doi:10.1016/j.clnu.2021.01.028
Kalantar-Zadeh K, Joshi S, Schlueter R, et al. Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease. Nutrients. 2020;12(7):1931. doi:10.3390/nu12071931
Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet. 2021;398(10302):786-802. doi:10.1016/S0140-6736(21)00519-5
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