Quality-oriented diet therapy for chronic kidney disease

Traditional dietary advice for people living with chronic kidney disease (CKD) focused predominantly on the quantity of energy and protein provided by the diet as well as restricting the consumption of single micronutrients. However, flaws in the assumptions that underlie this quantity-based approach have led to re-examination of medical nutrition therapy for kidney-related conditions, with a shift towards recommending more varied and liberalized plant-rich diets with a focus on dietary quality. Although clinical practice guidelines for patients with CKD have cautiously acknowledged this shift, less advice is available on how to translate new knowledge into practical and feasible recommendations that describe which foods patients should be advised to eat. In this Review, we provide a framework for the delivery of quality-oriented diet therapy for people with CKD based on the dietary principles of balance, variety and moderation. This approach also requires consideration of the manner in which foods are processed, prepared and integrated into the diet. Successful implementation requires a flexible, individualized approach that involves consideration of both CKD-specific and general dietary factors as well as potential barriers, challenges and behavioural determinants of the patient's dietary choices and habits.