Why the Nutritional Management of Acute Versus Chronic Kidney Disease Should Differ

Precision Nutrition and Personalized Diet Plan for Kidney Health and Kidney Disease Management

“…6 While patients with stable CKD and slow disease progression and persons with a solitary kidney may benefit from avoiding high protein intake, during an acute kidney injury, including an acute kidney injury on CKD episode, a higher protein intake may be beneficial for faster kidney recovery during this catabolic event, although data are not consistent. 7 Certain food constellations may help with specific CKD etiologies. A gluten-free and dairy-free diet may be useful in children with steroid-resistant nephrotic syndrome or focal segmental glomerulosclerosis.…”

“… 6 While patients with stable CKD and slow disease progression and persons with a solitary kidney may benefit from avoiding high protein intake, during an acute kidney injury, including an acute kidney injury on CKD episode, a higher protein intake may be beneficial for faster kidney recovery during this catabolic event, although data are not consistent. 7 …”

Engaging Nutrition and Diet for Primary, Secondary, and Tertiary Prevention of Kidney Disease: The World Kidney Day 2020

“…3 The Journal of Renal Nutrition (JREN) takes pride in its recent contributions to the important discussions and publications to reinvigorate the use of low-protein diets with emphasis on more plant-based sources along with novel nutritional and dietary interventions that can slow CKD progression or prevent kidney failure. 4,5 We believe that both traditional and novel nutritional and dietary interventions are quintessential complementary parts to any pharmacologic strategies for prevention of CKD and that efficacy of such medications as angiotensin-pathway modulators can be enhanced or handicapped if important lifestyle and modifications, in particular dietary interventions, are pursued or ignored, respectively. 6,7 A relevant study to the topic of primary CKD prevention is by Mirmiran et al 8 in this issue of JREN.…”

Implementing the “Advancing American Kidney Health Initiative” by Leveraging Nutritional and Dietary Management of Kidney Patients

“…The Renal Nutrition community enthusiastically welcomes this timely EO and reminds the government and all stakeholders that in the midst of these positive developments, it is important to reiterate the critical role of nutritional and dietary interventions to achieve and enhance these goals in persons with or at risk for kidney disease. As discussed in our previous commentaries, [2][3][4] under the context of secondary prevention in persons with earlier signs of CKD including microalbuminuria or renal hyperfiltration, for both persons with native kidneys and kidney transplant recipients, eating low-sodium (,2.3 g/ day) and low-protein (0.6-0.8 g/kg/day) foods should be the cornerstone of nonpharmacologic approaches. These measures can also result in slowing CKD progression and avoiding or delaying ESRD transition.…”

“…8 Emerging data suggest that Americans eat increasingly more protein (1.3-1.4 g/kg/day) than the Recommended Dietary Allowance (0.8 g/kg/day) 9 and that this high protein intake, by virtue of causing increased intraglomerular pressure with resultant glomerular hyperfiltration, may affect kidney health over time across populations at risk for kidney disease. 4,10 Hence, a low-sodium with low-protein lifestyle should be the general recommendation in our plight for kidney health, and higher intake of plant-based foods with high fibers along with complex carbohydrates with resistant starch (see below) and monounsaturated and polyunsaturated fats should be encouraged. 3,11 Among persons at higher risk of CKD are the kidney transplant donors with a solitary kidney, in whom higher intake of sodium (.4 g/day) and protein (.1 g/ kg/day) and higher body mass index (.30 kg/m 2 ) should be avoided in an effort to achieve the greatest kidney longevity and rejuvenation.…”