Unexpected development of Wernicke's encephalopathy in a patient with non-dialysis-dependent chronic kidney disease

Wernicke's encephalopathy (WE) is a life-threatening neuropsychiatric syndrome resulting from thiamine deficiency. Alcohol misuse is the main cause. However, non-alcoholic cases, including those associated with hyperemesis gravidarum and cancer, have also been reported. We herein report a case of WE in a patient with G4 stage, non-dialysis-dependent chronic kidney disease (CKD). The patient strongly believed that an extremely-low-protein diet would prevent the development of CKD. His estimated daily thiamine intake (0.37 mg) was less than one-third of the recommended level (1.3 mg). This case indicates the diverse etiologies of WE and provides insights into nutritional management for patients with CKD.