Of all the questions patients have for their physicians, dietary-related questions are some the most common. In the CKD population, this is no exception. Because there are so many unreliable sources spreading misinformation, it doesn’t make our jobs any easier.
But it’s not as restrictive as some patients might think. The CKD diet aligns with the same healthy eating recommendations of the general population. It’s not based on deprivation or excessive restriction. Read “Delivering the Diet News to Reluctant Patients.”
Current CKD diet guidelines combine CKD nutrition prescriptions and a healthy diet, such as the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) Diet.
Calorie Requirements for a CKD Diet
Consuming adequate amounts of food (calories) remains vital to good health as malnutrition can be as high as 41 percent in CKD patients. Calorie requirements for stable CKD patients are 30 to 35 kcal/kg/IBW/day, which is the same as the general population.
Remember, an adequate calorie intake allows protein intake to be used for protein function rather than being burned for energy.
Protein for Chronic Kidney Disease Patients
The amount of protein in a CKD diet varies according to the patient’s eGFR. In patients with an eGFR over 25cc/min, the amount of protein should be 0.8 g/kg/day. For eGFR less than 25cc/min, protein should be lower at around 0.6 g/kg/day.
Evidence strongly suggests that as CKD progresses, lower protein diets delay the need for maintenance dialysis by decreasing uremic symptoms and metabolic complications related to acidosis, hyperkalemia, hyperphosphatemia and high sodium.
Plant-Based and Animal-Based Protein
CKD patients should aim for a combination of animal and plant-based protein. Proper protein intake in CKD patients requires a balance between getting enough protein for good nutrition, but not so much that it causes uremic symptoms.
Plant-based protein diets consisting of soy or nuts, in contrast to animal-based protein diets, lower the renal acid load, advanced glycation end products (AGE), saturated fats and phosphorus absorption.
After protein, the remaining calories should include non-digestible forms of carbohydrates including beans, peas, fruits, and whole grains. Less than 30 percent of caloric intake should come from fats.
Watching Potassium and Phosphorus Intake in a CKD Diet
Potassium and phosphorus are two important elements that need to be followed carefully in patients with CKD. Dietary changes for these elements are based on the patient’s renal function, medications and co-morbid conditions.
One problem with the DASH diet is the emphasis on low-fat dairy at three servings per day, which equals a total of 700mg of phosphorus a day. As CKD advances, low-fat dairy servings should be limited to one serving per day depending on the intake of other phosphorus foods. Calcium intake should not exceed 1500 mg per day.
Getting Patients to Accept Dietary Changes
In summary, for most CKD patients, the optimal diet is similar to the DASH and Mediterranean diet with an emphasis on food quality:
- Whole grains
One thing to watch out for is the number of protein foods in this diet. An optimal CKD diet would limit protein to 0.6 to 0.8 grams/kg/day with adjustments as CKD progresses and if issues with potassium or phosphorus develop.
This dietary pattern emphasizes positive messages and should improve the acceptance of CKD dietary interventions among patients with CKD.
Get the Patient Education Tools You Need
Learn how we can help you educate your CKD patients and help them succeed with their treatment plans with our Physician-Directed Chronic Kidney Disease Patient Education Program.
Source: DASH and Mediterranean Diets as Nutritional Interventions for CKD Patients; Gallieni, Maurizio Cupisti, Adamasco et al; American Journal of Kidney Diseases, Volume 68, Issue 6, 828 – 830
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