Table 1.

Summary of selected nutrition requirements for adults with varying stages of chronic kidney disease (CKD) as recommended by published guidelines

Nutrient	CKD stages 3–5 without maintenance dialysis (GFR categories 3–5)	CKD stage 5 with maintenance dialysis (kidney failure)	Post-transplant (guided by CKD stage/category of kidney function)
Proteina	0.6–0.8 g/kg/day of BW with at least 50% HBV to potentially slow disease progression (particularly in diabetics) and achieve/maintain adequate serum albumin OR 0.3 g/kg/day of BW supplemented with keto acids	1.1–1.5 g/kg/day of BW (HD) with at least 50% HBV to achieve/maintain adequate serum albumin levels in conjunction with sufficient protein-sparing caloric intake	0.8–1.0 g/kg/day of BW with 50% coming from HBV
Energy	25–35 kcal/kg/day of BW to achieve or maintain goal body weight	25–35 kcal/kg/day of BW to achieve or maintain goal body weight; include estimated caloric absorption from PD fluid as applicable	25–35 kcal/kg/day of BW to achieve or maintain goal body weight
Fat	General population recommendation of <30% of total calories from fat; emphasis on healthy fat sources	Focus on type of fat and carbohydrate to manage dyslipidemia; pattern unique in CKD	Focus on type of fat and carbohydrate to reduce cardiovascular risk or manage immunosuppressant medication adverse effect (dyslipidemia, glucose intolerance)
Saturated fat	Same as for general population; <7% of total fat	Reduce and substitute saturated fat sources with healthier fat sources	Reduce and substitute saturated fat sources with healthier fat sources
Sodium	General population recommendation of ≤2.3 g/day; individualize in conjunction with fluid	2.0–3.0 g/day (HD) to control interdialytic fluid gain; 2.0–4.0 g/day (PD) to control hydration status	General population recommendation of ≤2.3 g/day
Potassium	Typically not restricted until hyperkalemia is present, then individualized	2.0–4.0 g/day or 40 mg/kg/day of BW in HD or individualized in PD to achieve normal serum levels	Not restricted unless hyperkalemia is present, then individualized
Calcium	Not restricted	2 g elemental/day from dietary and medication sources	Individualized to kidney function
Phosphorus	Typically not restricted until hyperphosphatemia is present, then individualized to maintain normal serum levels by diet and/or phosphate binders	800–1,000 mg/day to achieve goal serum level of 3.5–5.5 mg/dL or below; coordinate with oral phosphate binder prescription	Individualized to stage of kidney function
Fiber	Same as general population; 25–35 g/day	Same as general population; 25–35 g/day	Same as general population; 25–35 g/day
Fluid	Typically not restricted unless clinically indicated	1,000 mL/day (+ urine output if present) in HD; greater in PD individualized to fluid status	No restriction; matched to urine output if appropriate

Note:

^aSee special considerations for vegetarians.16 Reprinted from Beto JA, Ramirez WE, Bansal VK. Medical nutrition therapy in adults with chronic kidney disease: integrating evidence and consensus into practice for the generalist registered dietitian nutritionist. J Acad Nutr Diet. 2014;114(7):1077–1087.7 Copyright © 2014, with permission from Elsevier.

Abbreviations: BW, body weight; GFR, glomerular filtration rate; HBV, high biological value; HD, hemodialysis; PD, peritoneal dialysis.