Nutritional Management in Chronic Kidney Disease According to Disease Stages

When you suffer from chronic kidney disease, nutritional management is an essential part of your treatment plan. Depending on the severity of your disease, your recommended diet may change over time. Especially, in a more advanced stage of your disease when your glomerular filtration rate (GFR) continues to decrease, the amount of protein together with calories and other nutrients (e.g. minerals and vitamins) in your diet have to be adjusted to meet your changing needs.

Please note that the following nutrients should be carefully monitored if you suffer from chronic kidney disease:

  • Protein 
  • Phosphate 
  • Calcium 
  • Potassium 
  • Sodium 
  • Fluid

Additionally it is important, that your nutrition contains enough calories (energy), because many patients develop malnutrition, particularly in later stages of the disease.

Basically, nutrition in chronic kidney disease should contain:

  • Low amounts of table salt (i.e. sodium) 
  • Low amounts of phosphate 
  • Sufficient calories 
  • Low amounts of protein in predialysis stages 
  • High amounts of protein in dialysis stage

Please ask your doctor to refer you to a skilled dietician who will support you in understanding the changing needs within the different stages of your disease and who will help you with the composition of your diet.

Nutritional requirements change within the different stages of CKD.

Main changes during disease progression

There are major differences in the nutritional recommendations during the predialysis phase and the dialysis phase of chronic kidney disease.

1. Predialysis

In predialysis stages of chronic kidney disease it is advisable to reduce your daily protein intake substantially compared to your familiar diet. High amounts of protein would damage the nephrons in your kidneys. Every protein ingested above the daily requirement will increase the appearance of uraemic symptoms and enhance the progression of kidney disease. For these reasons at least, protein should be limited to the recommended intake of 0.7-0.8 g/kg ideal body weight/day.

However, even more efficient is a marked restricted protein intake (0.3/0.4-0.6 g/kg body weight/day) supplemented with essential keto acids/amino acids. This is indicated with a decline of GFR below the value of 60 to 50 ml/min. Both kinds of dietary protein restriction ensure that you will stay in a good nutritional status. In this respect, please note that you have to receive sufficient amounts of energy as well as adequate amounts of other essential nutrients (e.g. minerals and vitamins).

Read more about nutrition in predialysis
Read more about proteins
Read more about energy

2. Dialysis

When dialysis treatment becomes necessary, your dietary support has to change completely. Due to the enhanced protein losses through the dialysis procedure and excess catabolism secondary to the haemodialysis session, your daily protein intake has to be increased to 1.2 g protein/kg body weight/day or more.

Your daily energy intake should remain constant at 30-35 kcal/kg body weight/day or preferably higher according to your physical activity or if you are below 60 years of age. Of even more importance becomes the monitoring of the intake of fluids and of specific compounds such as phosphate and potassium. With respect to phosphate, this is a tricky topic: increasing dietary protein intake always parallels with an increased intake of phosphate! Please ask for the support of a trained dietician to clarify these difficulties and to receive help in planning your diets.

Read more about nutrition and haemodialysis
Read more about nutrition and peritoneal dialysis
Read more about proteins
Read more about energy

Content last updated
  1. Cano N, Fiaccadori E, Tesinsky P et al.: ESPEN Guidelines on Enteral Nutrition: Adult Renal Failure. Clin Nutr 2006; 25: 295–310.
  2. Fouque D: Should we still prescribe a reduction in protein intake for CKD patients? Am J Nephrol 2006; 26(Suppl 1): 7-9.
  3. Nutritional therapy in patients with chronic kidney disease: protein-restricted diets supplemented with keto/amino acids. Consensus statement from the international advisory board meeting 2006. Am J Nephrol 2006; 26(Suppl 1): 25-27.
  4. National Kidney Foundation: NKF K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kidney Dis 2000; 35(Suppl 2): S1-S140. (last visited 20.04.2010)
  5. Toigo G, Aparicio M, Attman PO et al.: Expert Working Group report on nutrition in adult patients with renal insufficiency (part 1 of 2). Clin Nutr 2000; 19(3): 197-207.

Did you know...?

  • A keto acid is the nitrogen-(NH3)-free analogue of an amino acid.

  • In CKD patients, serum concentrations of phosphate are elevated. Due to the possible impact on bone meatbolism, a decrease in serum phosphate is necessary.

  • Since a protein-restricted diet is mainly a vegetarian diet, meat, fish, eggs, cheese, milk and milk products are not allowed in huge amounts.

  • Compliance with a low-protein diet is the cornerstone of the efficacy of such a nutritional regimen.

  • Preservatives contain phosphate, e.g. E 322, E 338, E 339, E 340, E 341, E 450.

  • One gram protein contains 15-18 mg phosphate.

  • Cooking reduces the potassium content in vegetables and fruits by 50 %.

  • Salt substitutes contain considerable amounts of potassium: 1 g of salt substitute contains the potassium amount of one banana.

  • A soaked potato contains half of the potassium-content of a normal cooked potato.

  • Table salt is a combination of sodium and chloride: 1 g table salt = 400 mg sodium and 600 mg chloride.

  • One serving of cornflakes contains 1.1 g table salt.