[Nutrition guidelines for advanced chronic kidney disease (ACKD)]

Prescription of protein intake in CKD is complicated by potential conflicts between goals to delay progression of CKD and preserve nutritional status. Providing a protein intake of about 0.75 g/kg/day appears reasonable in patients with GRF > 30 mL (CKD stages 1-3). In CKD stage 4 and 5, it is recommended to provide a protein intake of about 0.6 g/kg/day to slow progression and minimize accumulation of uremic toxins. - Maintaining adequate energy intake is essential in all stages of CKD. - Assessment of nutritional status in CKD requires multiple markers to assess protein status, fat stores, body composition, and protein and energy intake. - PEM can be considered as an indication for the initiation of kidney replacement therapy. If PEM develops or persists despite attempts to optimize intake, and there is no apparent cause for malnutrition other than intake or anorexia, initiation of dialysis or kidney transplant is indicated in patients with GFR > 15 mL/min. - Nutritional treatment for patients with CKD should include nutritional assessment and education and nutritional planning and follow-up.