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Nutritional Management of

Chronic Kidney Disease

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

Altered protein
and energy
homeostasis •May distort

Altered GI Muscle and fat

absorption wasting

•Uremia •Comorbid conditions

microbiome exacerbate
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


• <0.6g/kg + supplementation of essential

AA or their ketoacids

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

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

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

Moderately low and high levels of

potassium are associated with CKD
progression options,
pro CVD

Lower potassium usually recommended:

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

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

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
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

 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