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Chronic Kidney Disease and Nutrition
Depending on the stages of CKD, it is recommended to follow a low-protein diet to protect the kidneys and limit the complications of CKD. The National Kidney Foundation and the Academy of Nutrition and Dietetics recommend that non-diabetic CKD patients, who are not on dialysis, have a protein intake of 0.55 to 0.6 g/kg body weight per day, and for those with diabetes, a protein intake of 0.6 to 0.8 g/kg body weight per day. This corresponds to a much lower protein intake than what most people typically consume.
For highly motivated patients, it is also possible to try a keto analog supplement combined with a vegan diet that is very low in protein (0.28 to 0.43g/kg body weight per day). Keto analogs are essential nitrogen-free amino acids. A diet low in essential amino acids can lead to a loss of muscle mass and a negative nitrogen load. Adding keto analogs can help avoid deficiencies and improve nitrogen balance. Recent research has recognized several potential benefits of a very low protein diet when combined with keto analog supplementation, including slowing the progression of CKD, decreasing the presence of uremic toxins, reducing electrolyte abnormalities, and delaying the need to start renal replacement therapy. In patients choosing this avenue, clinical monitoring with a physician and a Registered Dietitian is essential.
In addition to protein intake, it is important to pay attention to certain electrolytes, including sodium, phosphorus, and potassium, whose elimination is impaired by reduced kidney function and whose accumulation leads to various complications, including hyperparathyroidism, which is characterized by an excess of the parathyroid hormone (PTH) in the blood. PTH is produced by the parathyroid glands, four glands which are located at the back of the thyroid, and play an essential role in maintaining normal circulating calcium levels, blood pressure, and heart rate.
A low-sodium diet is essential for reducing blood pressure and proteinuria, and helping to preserve kidney function. A maximum daily intake of 2300 mg of sodium is recommended. To do this, table salt must be replaced with spice-based alternatives, and processed foods, as well as eating out, must be greatly limited.
In some cases, it may be recommended to adjust the dietary intake of phosphorus and/or potassium to maintain normal serum levels. It is a good idea, when making decisions on phosphorus restriction, to take into account the bioavailability of phosphorus sources. Thus, it is mainly recommended to limit sources of phosphorus from animals sources (e.g., dairy products) and from food additives (e.g., sodium phosphate, sodium tripolyphosphate, and phosphoric acid, found among other sources in soft drinks, cold cuts, frozen meals, dehydrated mixes, and fast food) rather than vegetable sources. Potassium is found in many fruits and vegetables. If the blood potassium level is too high, it is recommended to choose fruits and vegetables from among those that are lower in potassium.
Conclusion
Given the variability of residual renal function states and the complexity of different nutritional therapies, it is always advisable to consult with a Registered Dietitian in order to maintain a varied and balanced diet.
Sources
1. Charles et al. (2020) Chronic Kidney Disease. Prim Care;47(4):585-59
2. Ammirati, Chronic Kidney Disease. Rev Assoc Med Bras (1992). 2020
3. Ikizler et al. (2020) KDOQI Clinical Practice Guidelines for Nutrition in CKD: 2020 Update. AJKD; 73(3): S1-107.
4. Gluba-Brzózka, Franczyk and Rysz (2017)Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe. Nutrients; 9 (374)
5. Binetti, Marcelli and Baisi, Manuale di nutrizione clinica e scienze dietetiche applicate. Società Editrice Universo 2016
6. https://www.edtnaerca.org/
Author
Antonella has 2 professional titles in nutrition because she graduated in Food Sciences (University of Genoa) and holds a master's degree in Nutrition (University of Bologna). She is also a biologist (University of Florence). She is a member of the Order of Biologists (ONB) since 2013 and a SINU member. Passionate about psycho-nutrition issues, her goal is to help her clients find a balance and a healthy and correct relationship with food and with their body.
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