Retarding chronic kidney disease (CKD) progression: a practical nutritional approach for non-dialysis CKD

Abstract

This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2nd International Conference of the European Renal Nutrition working group at ERA-EDTA-" Retarding CKD progression: readily available through comprehensive nutritional management?"and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections-basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD-linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention.

First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD)

What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed?

Is a body mass index (BMI) of 21 kg/m2 adequate?

What phosphate target should be pursued?

What are the nutritional habits in patients with incident CKD?

What protein needs and amount of dietary protein should be pursued?

Does the quality of protein matter?

What amount of dietary salt should be employed? How should this be obtained?

How should normal serum phosphate be achieved?

What diet should be recommended? Is a vegetarian diet an option?

Second visit: Major nutritional targets in non-dialysis CKD

Consequences of unintentional weight loss

What is the role of the renal dietitian in helping the patient adhere to a renal diet?

Intermediate visits: Nutritional follow-up in non-dialysis CKD

What treatment for calcium/parathyroid hormone (PTH) will affect CKD progression?

Final visits:

Would a dietary recall/intensive dietary education improve adherence with the diet?

Would a very-low-protein diet (VLPD)/ketodiet be indicated for this patient?