Protein recommendations for individuals with CKD stages 1-4

In CKD Stages 1 and 2, diet and lifestyle interventions are key for their potential to delay progression of kidney failure and reduce CVD risk. The recommendations are to prudently lower protein in the diet to the RDA. Although the research supporting this data may still be considered uncertain about the efficacy of a low protein diet on slowing the progression of CKD, it may also be considered safe since it is the RDA (Levey et al., 2006). Other interventions may include control of proteinuria, of high blood pressure, and blood sugar, and the use of an ACE inhibitor or ARB. In CKD Stages 3 and 4, there are more enthusiastic recommendations regarding protein, potassium, and phosphorous that influence diet decision making but are not necessarily employed in the earlier stages of CKD. In addition, we cannot neglect that these patients, despite our best efforts, often progress to Stage 5 CKD treated with peritoneal dialysis or hemodialysis. We must maintain an optimum nutritional status along the continuum of CKD Stages 1 to 5. Protein energy malnutrition is a predictor of morbidity and mortality in patients on dialysis (NKF, 2000). The goal for these patients is to be well nourished and kidney protected, which is a balancing act. Medicare supports medical nutrition therapy for registered dietitian (RD) services for patients with GFRs of 15 to 50 mL/min/1.73m2 (NKF, 2007). The RDs in nephrology are effective in reviewing the diet options and providing necessary guidance and support to individuals with CKD. These RDs are the nutrition information resource for practitioners treating patients with Stages 1 to 4 CKD.