Nutritional treatment of advanced CKD: twenty consensus statements

Abstract

The Italian nephrology has a long tradition and experience in the field of dietetic-nutritional therapy (DNT), which is an important component in the conservative management of the patient suffering from a chronic kidney disease, which precedes and integrates the pharmacological therapies. The objectives of DNT include the maintenance of an optimal nutritional status, the prevention and/or correction of signs, symptoms and complications of chronic renal failure and, possibly, the delay in starting of dialysis. The DNT includes modulation of protein intake, adequacy of caloric intake, control of sodium and potassium intake, and reduction of phosphorus intake. For all dietary-nutritional therapies, and in particular those aimed at the patient with chronic renal failure, the problem of patient adherence to the dietetic-nutritional scheme is a key element for the success and safety of the DNT and it can be favored by an interdisciplinary and multi-professional approach of information, education, dietary prescription and follow-up. This consensus document, which defines twenty essential points of the nutritional approach to patients with advanced chronic renal failure, has been written, discussed and shared by the Italian nephrologists together with representatives of dietitians (ANDID) and patients (ANED).

Inflammation and Oxidative Stress in Chronic Kidney Disease—Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites

“…↑Magnesium ↓CRP Human study; [84] ↑Selenium ↑GSH-Px ↓ROS Human study; [87] ↓Phosphate ↓FGF23 ↓PTH Human study; [90,92,123,124] ↑Vitamin C ↑hydroxylase/monooxygenase co-factor ↓MDA ↓tissue lipid oxidation ↑tissue GSH ↑Co-antioxidant vit.E ↓ROS Human study; [98] Animal model; [99] ↑Vitamin E ↓8-OHdG ↓lipid peroxidation ↓NADPH activity ↓inflammatory mediators Cellular and animal model; [101] Animal model; [102] Human study; [108] ↑Vitamin D ↓NF-kB signling pathway ↓RAAS ↓TGF-β/Smad ↓Wnt/β-catenin Animal model; [114] Cellular and animal model; [115] Animal model; [116] Cellular and animal model; [117] ↑Vitamin A ↓TLR4/NF-kB signling pathway Animal model; [118] ↑Vitamin B1 ↓plasma lactate levels Human study; [119]…”

“…Several natural-derived agents have been used in Chinese herbal medicine, including flavonoids (or bioflavonoids), which form an important group of secondary plant metabolites ( Table 2). Many studies have provided evidence supporting the importance of nutrition during CKD; in particular, the role of nutrition in regulating the levels of gut-derived uremic toxins has been demonstrated to be beneficial in CKD patients [45,[123][124][125][126].…”

“…The objectives of nutritional therapy include the maintenance of an optimal nutritional status; the prevention and/or correction of signs, symptoms and complications of CKD; and, possibly, delaying the need for dialysis. Such diets include modulation of protein intake, adequate caloric intake, control of sodium and potassium intake and reduction of phosphorus intake [123]. Recent evidence has shown a connection between the kidneys and the intestines.…”

Sex Differences in the Progression of CKD Among Older Patients: Pooled Analysis of 4 Cohort Studies

“…22 Protein intake was estimated by using the formula of Maroni et al 23 Low-protein diet was defined as protein intake ≤ 0.8 g/kg/d, and lowsodium diet was defined as 24-hour urinary sodium excretion ≤ 100 mmol (corresponding to 6 g of sodium chloride). 24,25 GFR was estimated using the CKD-EPI equation; because creatinine was not standardized, we reduced creatinine values by 5%. 26…”

Nutritional Challenges in Pregnant Women with Renal Diseases: Relevance to Fetal Outcomes

“…Indeed, a diet containing sufficient amounts of macro-and micronutrients is essential to fetus organogenesis, whereas adverse nutritional conditions during pregnancy may permanently change the structure and function of specific organs, exposing the offspring also to the risk to develop adult diseases [14]. The difficulty to provide the correct nutrition in pregnant women is further complicated in CKD patients, in whom nutritional therapy is a cornerstone of the clinical management of renal diseases [15]. So, in pregnant CKD women, there is the need to maintain a constant balance between the specific pregnancy-and disease-related nutritional needs, aiming to achieve both optimal nutrient intakes to promote fetal growth and development, and adequate metabolic control of the renal disease.…”