Table 5.
Macronutrient recommendations in DKD
| Organization | Lower ranges of dietary protein intake | Higher ranges of dietary protein intake | Carbohydrate | Fatty acids | Sodium |
|---|---|---|---|---|---|
| KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (22) | 0.8 g protein/kg/day in adults with diabetes and GFR <30 mL/min/1.73 m2 with appropriate education | Avoid protein intake >1.3 g/kg/day in adults with CKD at risk for progression; specific comment for DKD not provided | Specific recommendation not provided | Specific recommendation not provided | Lower salt intake to <2 g of sodium per day (5 g of sodium chloride), unless contraindicated |
| KDOQI 2007 Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease (4) | Recommended dietary allowance of 0.8 g/kg body weight per day for people with DKD and CKD stages 1–4 | Avoid high-protein diets defined as ≥20% of total daily calories | Specific recommendation not provided | Increase intake of omega-3 and omega-9 fatty acids | Reduction of intake 2.3 g/day as recommended by the DASH diet |
| ADA Standards of Medical Care in Diabetes—2014 (20) and Nutrition Therapy Recommendations for the Management of Adults With Diabetes (136) | Maintain usual level of dietary protein intake (136); approximated by reported studies surveying diet intake in people with diabetes to be approximately 16–18% of total calories (20) | Specific comment not provided | Specific recommendation for DKD not provided. For diabetes, include carbohydrates from vegetables, fruits, whole grains, legumes, and dairy products over intake from carbohydrates containing added sugar, fat, and sodium. Avoid beverages, products with high-fructose corn syrup, and sucrose | Total fat: individualized | Specific recommendation for DKD not provided |
| Omega-3: same recommendation as for general public. Cholesterol, saturated, trans fats: same as for general public | For individuals with diabetes, reduce sodium to <2,300 mg/day as recommended for the general public | ||||
| Mono- and polyunsaturated fats: integrated to comment regarding potential benefits of a Mediterranean diet pattern |