Nutritional support for patients with chronic kidney disease at pre-dialysis stages

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Chronic kidney disease (CKD) is characterized by poor outcomes, an increasing frequency of new cases, the need for expensive method of renal replacement therapy at the terminal stage. The main task facing the doctor is slowing the progression of CKD and delay the start of dialysis by applying the nephroprotective strategy, of which diet therapy is an essential part. The key components of the diet for CKD patients are reducing sodium intake to 2.3 g per day in order to improve control of blood pressure (BP), dietary protein restriction adequate to renal function – from 0.8 to 0.3 g/kg of body weight per day combined with the prescribing of ketoanalogues of essential amino acids, hyperglycemia control. With the progression of CKD, the main objectives of the diet therapy are the prevention/correction of complications: protein-energy waisting, metabolic acidosis, ensuring sufficient calories, corresponding to the body’s energy expenditures (30–35 kcal/kg of body weight per day), limiting phosphate intake to 0.8–1 g a day, restriction of food potassium. Low-protein diet in combination with ketoanalogues of amino acids, regular monitoring and correction of the nutritional status of patients at the pre-dialysis stages of CKD is an effective and safe method of nephroprotection, which allows delaying the start of dialysis.

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About the authors

Alexandra V. Kuzmina

European Medical Center

Author for correspondence.
ORCID iD: 0000-0003-3913-0366

Russian Federation, Moscow

врач терапевт, нефролог


  1. KDIGO 2012 Clinical Practice Guidelines for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(Issue 1):1-127.
  2. Нефрология. 2010;14(3) [Nephrology. 2010;14(3) (In Russ.)]. doi: 10.24884/1561-6274-2010-14-3
  3. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013 Jul 20;382(9888):260-72. doi: 10.1016/S0140-6736(13)60687-X
  4. Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PloS One. 2016;11(7):e0158765. doi: 10.1371/journal.pone.0158765
  5. Hallan SI, Coresh J, Astor BC, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol. 2006;17:2275-84. doi: 10.1681/ASN.2005121273
  6. Chen N, Wang W, Huang Y, et al. Community-based study on CRD subjects and the associated risk factors. Nephrol Dial Transplant. 2009;24:2117-23. doi: 10.1093/ndt/gfn767
  7. Victorsdottir O, Palsson R, Andresdottir MB, et al. Prevalence of chronic kidney disease based on estimated glomerular fi ltration rate and proteinutia in Icelandic adults. Nephrol Dial Transplant. 2005;20:1799-807. doi: 10.1093/ndt/gfh914
  8. Nitsch D, Dietrich DF, von Eckardstein A, et al. Prevalence of renal impairment and its association with cardiovascular risk factors in a general population, results of the Swiss SAPALDIA study. Nephrol Dial Transplant. 2006;21:935-44. doi: 10.1093/ndt/gfk021
  9. Электронный портал Российского диализного общества [Russian Dialysis Society (In Russ.)].
  10. Бикбов Б.Т., Томилина Н.А. Состав больных и показатели качества лечения на заместительной терапии терминальной хронической почечной недостаточности в Российской Федерации в 1998–2013 гг. Отчет по данным регистра заместительной почечной терапии Российского Диализного Общества. Часть вторая [Tomilina NA, Bikbov BT. Renal replacement therapy for end-stage renal disease patients in russian federation, 1998–2011 (Report of the Russian Registry of Renal Replacement Therapy). Russian Journal of Transplantology and Artificial Organs. 2015;17(1):35-58 (In Russ.)]. doi: 10.15825/1995-1191-2015-1-35-58
  11. Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164:659. doi: 10.1001/archinte.164.6.659
  12. Philip Kam-Tao Li, Guillermo Garcia-Garcia, Siu-Fai Lui, et al. Kidney Health for Everyone Everywhere – From Prevention to Detection and Equitable Access to Care. J Nephrol. 2020 Apr;33(2):201-10. doi: 10.1007/s40620-020-00728-x.
  13. IOM (Institute of Medicine). Sodium Intake in Populations: Assessment of Evidence. Washington, D.C.: National Academy Press; 2013. doi: 10.17226/18311
  14. Available from: of Evidence.aspx
  15. Zeeuw D, Remuzzi G, Parving H, et al. Proteinuria, a Target for Renoprotection in Patients with Type 2 Diabetic Nephropathy: Lessons from RENAAL. Kidney Int. 2004;65(6):2309-20. doi: 10.1111/j.1523-1755.2004.00653.x
  16. Snyder RW, Berns JS. Use of Insulin and Oral Hypoglycemic Medications in Patients with Diabetes Mellitus and Advanced Kidney Disease. Semin Dialysis. 2004;17(5):365-70. doi: 10.1111/j.0894-0959.2004.17346.x
  17. Kaysen GA, Johansen KL, Cheng S, et al. Trends and Outcomes Associated with Serum Albumin Concentrations Among Incident Dialysis Patients in the United States. J Renal Nutr. 2008;18(4):323-31. doi: 10.1053/j.jrn.2008.04.002
  18. Gennari FJ, Hood VL, Greene T, et al. Effect of Dietary Protein Intake on Serum Total CO2 Concentration in Chronic Kidney Disease: Modification of Diet in Renal Disease Study Findings. Clin J Am Soc Nephrol. 2006;1(1):52-7. doi: 10.2215/CJN.00060505
  19. De Brito-Ashurst I, Varagunam M, Raftery MJ, Yaqoob MM. Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status. J Am Soc Nephrol. 2009;20(9):2075-84. doi: 10.1681/ASN.2008111205
  20. Скурихин И.М., Тутельян В.А. Химический состав российских химических продуктов. М., 2002; с. 21-181 [Skurikhin IM, Tutel’yan VA. Khimicheskii sostav rossiiskikh khimicheskikh produktov. Moscow, 2002; p. 21-181 (In Russ.)].
  21. Burrowes JD, Ramer NK. Removal of Potassium from Tuberous Root Vegetables by Leaching. J Renal Nutr. 2006;16(4):304-11. doi: 10.1053/j.jrn.2006.07.012
  22. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease – Mineral and Bone Disorder (CKD-MBD). Kidney Int. 2017;7(1):1-59.
  23. Palmer SC, Hayen A, Macaskill P, et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. JAMA. 2011;305:1119. doi: 10.1001/jama.2011.308
  24. Jamal SA, Vandermeer B, Raggi P, et al. Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet. 2013;382:1268. doi: 10.1016/S0140-6736(13)60897-1
  25. Patel L, Bernard LM, Elder GJ. Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials. Clin J Am Soc Nephrol. 2016;11:232. doi: 10.2215/CJN.06800615
  26. Di Iorio B, Bellasi A, Russo D, INDEPENDENT Study Investigators. Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol. 2012;7:487. doi: 10.2215/CJN.03820411
  27. Di Iorio B, Molony D, Bell C, et al. Sevelamer versus calcium carbonate in incident hemodialysis patients: results of an open-label 24-month randomized clinical trial. Am J Kidney Dis. 2013;62:771. doi: 10.1053/j.ajkd.2013.03.023
  28. Floege J, Covic AC, Ketteler M, et al. Long-term effects of the iron based phosphate binder, sucroferric oxyhydroxide, in dialysis patients. Nephrol Dial Transpl. 2015;30:1037-46. dialysis. doi: 10.1093/ndt/gfv006
  29. Kendrick J, Parameswaran V, Ficociello L, et al. One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients on Maintenance Hemodialysis. J Ren Nutr. 2019 Sep;29(5):428-37. doi: 10.1053/j.jrn.2018.11.002
  30. IOM (Institute of Medicine). Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
  31. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2012;2.
  32. Смирнов А.В., Кучер А.Г., Каюков И.Г., Цыгин А.Н. Диетотерапия при хронической болезни почек. В кн.: Нефрология. Национальное руководство. Краткое издание. Гл. ред. Н.А. Мухин. М.: ГЭОТАР-Медиа, 2016; с. 67. [Smirnov AV, Kucher AG, Kayukov IG, Tsygin AN. Dietoterapiya pri khronicheskoi bolezni pochek. V kn.: Nefrologiya. Natsional’noe rukovodstvo. Kratkoe izdanie. Gl. red. N.A. Mukhin. Moscow: GEOTAR-Media, 2016; p. 67 (In Russ.)].
  33. Monique E Cho, MD, Srinivasan Beddhu, MD. Dietary recommendations for patients with nondialysis CKD. UpToDate. Literature review current through: Feb 21, 2020.
  34. Menon V, Kopple JD, Wang X, et al. Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. Am J Kidney Dis. 2009;53:208. doi: 10.1053/j.ajkd.2008.08.009
  35. Mircescu G, Gârneaţă L, Stancu SH, Capusa C. Effects of a supplemented hypoproteic diet in chronic kidney disease. Ren Nutr. 2007 May;17(3):179-88. doi: 10.1053/j.jrn.2006.12.012
  36. Steiber AL, Kopple JD. Vitamin Status and Needs for People with Stages 3–5 Chronic Kidney Disease. J Renal Nutr. 2011;21(5):355-68. doi: 10.1053/j.jrn.2010.12.004
  37. Mitch WE, Walser M, Steinman TI, et al. The effect of a keto acid-amino acid supplement to a restricted diet on the progression of chronic renal failure. N Engl J Med. 1984;311:623. doi: 10.1056/NEJM198409063111002
  38. Zeller K, Whittaker E, Sullivan L, et al. Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus. N Engl J Med. 1991;324:78. doi: 10.1056/NEJM199101103240202
  39. Walker JD, Bending JJ, Dodds RA, et al. Restriction of dietary protein and progression of renal failure in diabetic nephropathy. Lancet. 1989;2:1411. doi: 10.1016/s0140-6736(89)92032-1
  40. Ihle BU, Becker GJ, Whitworth JA, et al. The effect of protein restriction on the progression of renal insufficiency. N Engl J Med. 1989;321:1773. doi: 10.1056/NEJM198912283212601
  41. Rosman JB, Langer K, Brandl M, et al. Protein-restricted diets in chronic renal failure: a four year follow-up shows limited indications. Kidney Int Suppl. 1989;27:S96.
  42. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994;330:877. doi: 10.1056/NEJM199403313301301
  43. Levey AS, Greene T, Beck GJ, et al. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol. 1999;10:2426.
  44. Fouque D, Laville M. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database Syst Rev. 2009:CD001892. doi: 10.1002/14651858.CD001892.pub3
  45. Liu Z, Su G, Guo X, et al. Dietary interventions for mineral and bone disorder inpeople with chronic kidney disease. Cochrane Database Syst Rev. 2015;9:CD010350. doi: 10.1002/14651858.CD010350.pub2
  46. Chewcharat A, Takkavatakarn K, Wongrattanagorn S, et al. The Effects of Restricted Protein Diet Supplemented With Ketoanalogue on Renal Function, Blood Pressure, Nutritional Status, and Chronic Kidney Disease-Mineral and Bone Disorder in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis. J Ren Nutr. 2020;30(3):189-99. doi: 10.1053/j.jrn.2019.07.005
  47. KDOQI Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease: 2019 Update. kdoqi-guidelines-commentary-nutrition
  48. Сигитова О.Н., Архипов Е.В., Ким Т.Ю. Анализ эффективности нефропротекции с применением малобелковой диеты и кетоаналогов аминокислот у пациентов с хронической болезнью почек. Кардиология. 2015;55(9):77-83. [Sigitova ON, Arkhipov EV, Kim TY. Analysis of the Effectiveness of Renoprotection of Low-Protein Diet and Ketoanalogues of Amino Acids In Patients With Chronic Kidney Disease. Kardiologiya. 2015;55(9):77-83 (In Russ.)]
  49. Garneata L, Stancu A, Dragomir D, et al. Ketoanalogue supplemented vegetarian very low-protein diet and CKD progression. Vegetarian Very Low Protein Diet and CKD Progression. J Am Soc Nephrol. 2016;27(7):2164-76. doi: 10.1681/ASN.2015040369
  50. Maroni BJ, Staffeld C, Young VR, et al. Mechanisms permitting nephrotic patients to achieve nitrogen equilibrium with a protein-restricted diet. J Clin Invest. 1997;99:2479. doi: 10.1172/JCI119432



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