Nutritional Management of Patients with Chronic Kidney Disease

Nutrition plays an important role in the management of patients with CKD because appropriate manipulation of diet can significantly ameliorate signs and symptoms of progressive loss kidney function. The nutritional status of the CKD patient also affects the beneficial responses to medicines and treatment strategies (such as responses to blockade of the RAAS).Providing adequate and appropriate nutrition is more likely to be successful if a skilled dietitian assists because patients need to learn how to avoid foods with potential harm (such as those high in phosphorus and salt). To prescribe a diet successfully, the calorie intake must be adequate to utilize other constituents of the diet optimally. In addition, there must be a sufficient quantity of dietary protein, but not an excess, which could exacerbate features of uremia. The requirements for trace elements, minerals, and vitamins may be critical for CKD patients. Simple methods to ascertain which patients are compliant with the prescribed protein/calorie intake and how to judge whether patients should be evaluated for occult gastrointestinal blood loss manifesting as an unusually elevated serum urea nitrogen may affect clinical care.