- Department of Nephrology, Chinese PLA General Hospital; State Key Laboratory of Kidney Diseases; National Clinical Research Center for Kidney Diseases; Chinese PLA Institute of Nephrology; Beijing 100853, P. R. China;
CAI Guangyan,
Email: caiguangyan@sina.com
Chronic kidney disease (CKD) has become an important public health problem that seriously affects the physical and mental health of Chinese people. Nutritional therapy has become one of the important treatments for CKD. Domestic and international guidelines for CKD clinical nutrition therapy have been introduced, and the intake of various nutrients in CKD patients, especially protein intake, has been guided. In recent years, with the continuous development of nutrition assessment and treatment, the content of the guidelines has gradually improved, but some views are still controversial. This article explains the relevant guidelines for the treatment of CKD at home and abroad to provide reference for the clinical nutritional treatment of CKD patients.
Citation： WANG Siyang, CAI Guangyan. Interpretation of guidelines on nutritional management of chronic kidney disease. West China Medical Journal, 2019, 34(7): 740-745. doi: 10.7507/1002-0179.201906187 Copy
| 1. | Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health, 2016, 4(5): e307-e319. |
| 2. | Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822. |
| 3. | Webster AC, Nagler EV, Morton RL, et al. Chronic kidney disease. Lancet, 2017, 389(10075): 1238-1252. |
| 4. | K/DOQI, National Kidney Foundation. Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis, 2000, 35(6 Suppl 2): S1-S140. |
| 5. | 林善锬, 谌贻璞, 钱家麒, 等. 慢性肾脏病蛋白营养治疗共识. 临床肾脏病杂志, 2006, 6(3): 143-145. |
| 6. | Mitch WE, Ikizler TA. Handbook of nutrition and the kidney. 6 ed. Philadelphia: Lippincott Williams & Wilkins Handbook Series, 2009: 92-242. |
| 7. | 黎磊石, 刘志红. 中国肾脏病学(下册). 北京: 人民军医出版社, 2008: 1358-1380. |
| 8. | Di Iorio BR, Marzocco S, Bellasi A, et al. Nutritional therapy reduces protein carbamylation through urea lowering in chronic kidney disease. Nephrol Dial Transplant, 2018, 33(5): 804-813. |
| 9. | Di Micco L, Di Lullo L, Bellasi A, et al. Very low protein diet for patients with chronic kidney disease: recent insights. J Clin Med, 2019, 8(5): 718. |
| 10. | Shimomura A, Matsui I, Hamano T, et al. Dietary L-lysine prevents arterial calcification in adenine-induced uremic rats. J Am Soc Nephrol, 2014, 25(9): 1954-1965. |
| 11. | Walser M, Hill S. Can renal replacement be deferred by a supplemented very low protein diet?. J Am Soc Nephrol, 1999, 10(1): 110-116. |
| 12. | Malvy D, Maingourd C, Pengloan J, et al. Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr, 1999, 18(5): 481-486. |
| 13. | Brunori G, Viola BF, Parrinello G, et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis, 2007, 49(5): 569-580. |
| 14. | Garneata L, Mircescu G. Effect of low-protein diet supplemented with keto acids on progression of chronic kidney disease. J Ren Nutr, 2013, 23(3): 210-213. |
| 15. | Piccoli GB, Deagostini MC, Vigotti FN, et al. Which low-protein diet for which CKD patient? An observational, personalized approach. Nutrition, 2014, 30(9): 992-999. |
| 16. | Rhee CM, Ahmadi SF, Kovesdy CP. Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials. J Cachexia Sarcopenia Muscle, 2018, 9(2): 235-245. |
| 17. | Zhang J, Xie H, Fang M, et al. Keto-supplemented low protein diet: a valid therapeutic approach for patients with steroid-resistant proteinuria during early-stage chronic kidney disease. J Nutr Health Aging, 2016, 20(4): 420-427. |
| 18. | Kopple JD. National Kidney Foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis, 2001, 37(1 Suppl 2): S66-S70. |
| 19. | Anon. Chapter 3: management of progression and complications of CKD. Kidney Int Suppl (2011), 2013, 3(1): 73-90. |
| 20. | Cupisti A, Brunori G, Iorio BRD, et al. Nutritional treatment of advanced CKD: twenty consensus statements. J Nephrol, 2018, 31(4): 457-473. |
| 21. | Academy of Nutrition and Dietetics. Chronic kidney disease (CKD): executive summary of recommendation. [2019-06-20]. http://www.andeal.org/topic.cfm?menu=5303&cat=3929. |
| 22. | KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis, 2007, 49(2 Suppl 2): S12-S154. |
| 23. | 中华医学会糖尿病学分会. 中国糖尿病医学营养治疗指南(2013). 糖尿病天地(临床), 2016, 10(7): 73-88. |
| 24. | 纪立农, 马方. 中国糖尿病医学营养治疗指南(2010). 北京: 人民军医出版社, 2011: 24. |
| 25. | Milovanova L, Fomin V, Moiseev S, et al. Effect of essential amino acid ketoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Klotho) in 3b-4 stages chronic kidney disease patients: a randomized pilot study. Clin Exp Nephrol, 2018, 22(6): 1351-1359. |
| 26. | Satirapoj B, Vongwattana P, Supasyndh O. Very low protein diet plus ketoacid analogs of essential amino acids supplement to retard chronic kidney disease progression. Kidney Res Clin Pract, 2018, 37(4): 384-392. |
| 27. | Li HM, Long Q, Shao CH, et al. Effect of short-term low-protein diet supplemented with keto acids on hyperphosphatemia in maintenance hemodialysis patients. Blood Purif, 2011, 31(1/2/3): 33-40. |
| 28. | Fouque D, Vennegoor M, Ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant, 2007, 22(2): 45-87. |
| 29. | Chen ST, Ferng SH, Yang CS, et al. Variable effects of soy protein on plasma lipids in hyperlipidemic and normalipidemic hemodialysis patients. Am J Kidney Dis, 2005, 46(6): 1099-1106. |
| 30. | Lu Q, Cheng L, Axelsson J, et al. No difference in nitrogen balance between standard prescriptions of hemodialysis and peritoneal dialysis. Blood Purif, 2008, 26(6): 511-517. |
| 31. | Sardesai VM. Introduction to clinical nutrition. Boca Raton: CRC Press, 2013: 434. |
| 32. | Lim VS, Ikizler TA, Raj DS, et al. Does hemodialysis increase protein breakdown? Dissociation between whole-body amino acid turnover and regional muscle kinetics. J Am Soc Nephrol, 2005, 16(4): 862-868. |
| 33. | 中华人民共和国国家卫生和计划生育委员会. 慢性肾脏病患者膳食指导: WS/T 557－2017, 2017. http://www.nhc.gov.cn/ewebeditor/2018/03/20180312095210298.pdf. |
| 34. | Na J, Jiaqi Q, Aiwu L, et al. Improved plasma amino acids pattern following 12 months of supplemented low-protein diet in peritoneal dialysis patients. Ren Fail, 2010, 32(6): 709-715. |
| 35. | Jiang N, Qian JQ, Sun WL, et al. Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrol Dial Transplant, 2009, 24(8): 2551-2558. |
| 36. | Jiang N, Qian J, Lin A, et al. Low-protein diet supplemented with keto acids is associated with suppression of small-solute peritoneal transport rate in peritoneal dialysis patients. Int J Nephrol, 2011, 2011: 542704. |
| 37. | Dong J, Li YJ, Xu R, et al. Ketoacid supplementation partially improves metabolic parameters in patients on peritoneal dialysis. Perit Dial Int, 2015, 35(7): 736-742. |
| 38. | Tian XK, Wang T, et al. A low-protein diet does not necessarily lead to malnutrition in peritoneal dialysis patients. J Ren Nutr, 2005, 15(3): 298-303. |
| 39. | Kopple JD, Shinaberger JH, Coburn JW, et al. Optimal dietary protein treatment during chronic hemodialysis. Trans Am Soc Artif Intern Organs, 1969, 15(15): 302. |
| 40. | Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. N Engl J Med, 2017, 377(18): 1765-1776. |
| 41. | Aparicio M, Bellizzi V, Chauveau P, et al. Protein-restricted diets plus keto/amino acids--a valid therapeutic approach for chronic kidney disease patients. J Ren Nutr, 2012, 22(2 Suppl): S1-S21. |
| 42. | Lew QJ, Jafar TH, Koh HW, et al. Red meat intake and risk of ESRD. J Am Soc Nephrol, 2017, 28(1): 304-312. |
| 43. | Teplan V, Valkovsky I, Teplan V, et al. Nutritional consequences of renal transplantation. J Ren Nutr, 2009, 19(1): 95-100. |
| 44. | Vanholder R, Fouque D, Glorieux G, et al. Clinical management of the uraemic syndrome in chronic kidney disease. Lancet Diabetes Endocrinol, 2016, 4(4): 360-373. |
| 45. | Beto JA, Bansal VK. Medical nutrition therapy in chronic kidney failure: integrating clinical practice guidelines. J Am Diet Assoc, 2004, 104(3): 404-409. |
| 46. | Daviglus ML, Greenland P, Stamler J, et al. Relation of nutrient intake to microalbuminuria in nondiabetic middle-aged men and women: International Population Study on Macronutrients and Blood Pressure (INTERMAP). Am J Kidney Dis, 2005, 45(2): 256-266. |
| 47. | Sikorska-Wisniewska M, Mika A, Sledzinski T, et al. Disorders of serum omega-3 fatty acid composition in dialyzed patients, and their associations with fat mass. Ren Fail, 2017, 39(1): 406-412. |
| 48. | Guebre-Egziabher F, Debard C, Drai J, et al. Differential dose effect of fish oil on inflammation and adipose tissue gene expression in chronic kidney disease patients. Nutrition, 2013, 29(5): 730-736. |
| 49. | He FJ, Marciniak M, Visagie E, et al. Effect of modest salt reduction on blood pressure, urinary albumin, and pulse wave velocity in white, black, and Asian mild hypertensives. Hypertension, 2009, 54(3): 482-488. |
| 50. | Slagman MC, Kwakernaak AJ, Yazdani SA, et al. Vascular endothelial growth factor C levels are modulated by dietary salt intake in proteinuric chronic kidney disease patients and in healthy subjects. Nephrol Dial Transplant, 2012, 27(3): 978-982. |
| 51. | Swift PA, Markandu ND, Sagnella GA, et al. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial. Hypertension, 2005, 46(2): 308-312. |
| 52. | McMahon EJ, Campbell KL, Bauer JD, et al. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database Syst Rev, 2015(2): CD010070. |
| 53. | Adema AY, de Borst MH, ter Wee PM, et al. Dietary and pharmacological modification of fibroblast growth factor-23 in chronic kidney disease. J Ren Nutr, 2014, 24(3): 143-150. |
| 54. | Selamet U, Tighiouart H, Sarnak MJ, et al. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: the Modification of Diet in Renal Disease Study. Kidney Int, 2016, 89(1): 176-184. |
| 55. | de Boer IH, Rue TC, Kestenbaum B. Serum phosphorus concentrations in the third National Health And Nutrition Examination Survey (NHANES III). Am J Kidney Dis, 2009, 53(3): 399-407. |
| 56. | Sullivan C, Sayre SS, Leon JB, et al. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA, 2009, 301(6): 629-635. |
| 57. | Bailey JL, Franch HA. Nutritional considerations in kidney disease: core curriculum 2010. Am J Kidney Dis, 2010, 55(6): 1146-1161. |
- 1. Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health, 2016, 4(5): e307-e319.
- 2. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
- 3. Webster AC, Nagler EV, Morton RL, et al. Chronic kidney disease. Lancet, 2017, 389(10075): 1238-1252.
- 4. K/DOQI, National Kidney Foundation. Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis, 2000, 35(6 Suppl 2): S1-S140.
- 5. 林善锬, 谌贻璞, 钱家麒, 等. 慢性肾脏病蛋白营养治疗共识. 临床肾脏病杂志, 2006, 6(3): 143-145.
- 6. Mitch WE, Ikizler TA. Handbook of nutrition and the kidney. 6 ed. Philadelphia: Lippincott Williams & Wilkins Handbook Series, 2009: 92-242.
- 7. 黎磊石, 刘志红. 中国肾脏病学(下册). 北京: 人民军医出版社, 2008: 1358-1380.
- 8. Di Iorio BR, Marzocco S, Bellasi A, et al. Nutritional therapy reduces protein carbamylation through urea lowering in chronic kidney disease. Nephrol Dial Transplant, 2018, 33(5): 804-813.
- 9. Di Micco L, Di Lullo L, Bellasi A, et al. Very low protein diet for patients with chronic kidney disease: recent insights. J Clin Med, 2019, 8(5): 718.
- 10. Shimomura A, Matsui I, Hamano T, et al. Dietary L-lysine prevents arterial calcification in adenine-induced uremic rats. J Am Soc Nephrol, 2014, 25(9): 1954-1965.
- 11. Walser M, Hill S. Can renal replacement be deferred by a supplemented very low protein diet?. J Am Soc Nephrol, 1999, 10(1): 110-116.
- 12. Malvy D, Maingourd C, Pengloan J, et al. Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr, 1999, 18(5): 481-486.
- 13. Brunori G, Viola BF, Parrinello G, et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis, 2007, 49(5): 569-580.
- 14. Garneata L, Mircescu G. Effect of low-protein diet supplemented with keto acids on progression of chronic kidney disease. J Ren Nutr, 2013, 23(3): 210-213.
- 15. Piccoli GB, Deagostini MC, Vigotti FN, et al. Which low-protein diet for which CKD patient? An observational, personalized approach. Nutrition, 2014, 30(9): 992-999.
- 16. Rhee CM, Ahmadi SF, Kovesdy CP. Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials. J Cachexia Sarcopenia Muscle, 2018, 9(2): 235-245.
- 17. Zhang J, Xie H, Fang M, et al. Keto-supplemented low protein diet: a valid therapeutic approach for patients with steroid-resistant proteinuria during early-stage chronic kidney disease. J Nutr Health Aging, 2016, 20(4): 420-427.
- 18. Kopple JD. National Kidney Foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis, 2001, 37(1 Suppl 2): S66-S70.
- 19. Anon. Chapter 3: management of progression and complications of CKD. Kidney Int Suppl (2011), 2013, 3(1): 73-90.
- 20. Cupisti A, Brunori G, Iorio BRD, et al. Nutritional treatment of advanced CKD: twenty consensus statements. J Nephrol, 2018, 31(4): 457-473.
- 21. Academy of Nutrition and Dietetics. Chronic kidney disease (CKD): executive summary of recommendation. [2019-06-20]. http://www.andeal.org/topic.cfm?menu=5303&cat=3929.
- 22. KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis, 2007, 49(2 Suppl 2): S12-S154.
- 23. 中华医学会糖尿病学分会. 中国糖尿病医学营养治疗指南(2013). 糖尿病天地(临床), 2016, 10(7): 73-88.
- 24. 纪立农, 马方. 中国糖尿病医学营养治疗指南(2010). 北京: 人民军医出版社, 2011: 24.
- 25. Milovanova L, Fomin V, Moiseev S, et al. Effect of essential amino acid ketoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Klotho) in 3b-4 stages chronic kidney disease patients: a randomized pilot study. Clin Exp Nephrol, 2018, 22(6): 1351-1359.
- 26. Satirapoj B, Vongwattana P, Supasyndh O. Very low protein diet plus ketoacid analogs of essential amino acids supplement to retard chronic kidney disease progression. Kidney Res Clin Pract, 2018, 37(4): 384-392.
- 27. Li HM, Long Q, Shao CH, et al. Effect of short-term low-protein diet supplemented with keto acids on hyperphosphatemia in maintenance hemodialysis patients. Blood Purif, 2011, 31(1/2/3): 33-40.
- 28. Fouque D, Vennegoor M, Ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant, 2007, 22(2): 45-87.
- 29. Chen ST, Ferng SH, Yang CS, et al. Variable effects of soy protein on plasma lipids in hyperlipidemic and normalipidemic hemodialysis patients. Am J Kidney Dis, 2005, 46(6): 1099-1106.
- 30. Lu Q, Cheng L, Axelsson J, et al. No difference in nitrogen balance between standard prescriptions of hemodialysis and peritoneal dialysis. Blood Purif, 2008, 26(6): 511-517.
- 31. Sardesai VM. Introduction to clinical nutrition. Boca Raton: CRC Press, 2013: 434.
- 32. Lim VS, Ikizler TA, Raj DS, et al. Does hemodialysis increase protein breakdown? Dissociation between whole-body amino acid turnover and regional muscle kinetics. J Am Soc Nephrol, 2005, 16(4): 862-868.
- 33. 中华人民共和国国家卫生和计划生育委员会. 慢性肾脏病患者膳食指导: WS/T 557－2017, 2017. http://www.nhc.gov.cn/ewebeditor/2018/03/20180312095210298.pdf.
- 34. Na J, Jiaqi Q, Aiwu L, et al. Improved plasma amino acids pattern following 12 months of supplemented low-protein diet in peritoneal dialysis patients. Ren Fail, 2010, 32(6): 709-715.
- 35. Jiang N, Qian JQ, Sun WL, et al. Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrol Dial Transplant, 2009, 24(8): 2551-2558.
- 36. Jiang N, Qian J, Lin A, et al. Low-protein diet supplemented with keto acids is associated with suppression of small-solute peritoneal transport rate in peritoneal dialysis patients. Int J Nephrol, 2011, 2011: 542704.
- 37. Dong J, Li YJ, Xu R, et al. Ketoacid supplementation partially improves metabolic parameters in patients on peritoneal dialysis. Perit Dial Int, 2015, 35(7): 736-742.
- 38. Tian XK, Wang T, et al. A low-protein diet does not necessarily lead to malnutrition in peritoneal dialysis patients. J Ren Nutr, 2005, 15(3): 298-303.
- 39. Kopple JD, Shinaberger JH, Coburn JW, et al. Optimal dietary protein treatment during chronic hemodialysis. Trans Am Soc Artif Intern Organs, 1969, 15(15): 302.
- 40. Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. N Engl J Med, 2017, 377(18): 1765-1776.
- 41. Aparicio M, Bellizzi V, Chauveau P, et al. Protein-restricted diets plus keto/amino acids--a valid therapeutic approach for chronic kidney disease patients. J Ren Nutr, 2012, 22(2 Suppl): S1-S21.
- 42. Lew QJ, Jafar TH, Koh HW, et al. Red meat intake and risk of ESRD. J Am Soc Nephrol, 2017, 28(1): 304-312.
- 43. Teplan V, Valkovsky I, Teplan V, et al. Nutritional consequences of renal transplantation. J Ren Nutr, 2009, 19(1): 95-100.
- 44. Vanholder R, Fouque D, Glorieux G, et al. Clinical management of the uraemic syndrome in chronic kidney disease. Lancet Diabetes Endocrinol, 2016, 4(4): 360-373.
- 45. Beto JA, Bansal VK. Medical nutrition therapy in chronic kidney failure: integrating clinical practice guidelines. J Am Diet Assoc, 2004, 104(3): 404-409.
- 46. Daviglus ML, Greenland P, Stamler J, et al. Relation of nutrient intake to microalbuminuria in nondiabetic middle-aged men and women: International Population Study on Macronutrients and Blood Pressure (INTERMAP). Am J Kidney Dis, 2005, 45(2): 256-266.
- 47. Sikorska-Wisniewska M, Mika A, Sledzinski T, et al. Disorders of serum omega-3 fatty acid composition in dialyzed patients, and their associations with fat mass. Ren Fail, 2017, 39(1): 406-412.
- 48. Guebre-Egziabher F, Debard C, Drai J, et al. Differential dose effect of fish oil on inflammation and adipose tissue gene expression in chronic kidney disease patients. Nutrition, 2013, 29(5): 730-736.
- 49. He FJ, Marciniak M, Visagie E, et al. Effect of modest salt reduction on blood pressure, urinary albumin, and pulse wave velocity in white, black, and Asian mild hypertensives. Hypertension, 2009, 54(3): 482-488.
- 50. Slagman MC, Kwakernaak AJ, Yazdani SA, et al. Vascular endothelial growth factor C levels are modulated by dietary salt intake in proteinuric chronic kidney disease patients and in healthy subjects. Nephrol Dial Transplant, 2012, 27(3): 978-982.
- 51. Swift PA, Markandu ND, Sagnella GA, et al. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial. Hypertension, 2005, 46(2): 308-312.
- 52. McMahon EJ, Campbell KL, Bauer JD, et al. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database Syst Rev, 2015(2): CD010070.
- 53. Adema AY, de Borst MH, ter Wee PM, et al. Dietary and pharmacological modification of fibroblast growth factor-23 in chronic kidney disease. J Ren Nutr, 2014, 24(3): 143-150.
- 54. Selamet U, Tighiouart H, Sarnak MJ, et al. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: the Modification of Diet in Renal Disease Study. Kidney Int, 2016, 89(1): 176-184.
- 55. de Boer IH, Rue TC, Kestenbaum B. Serum phosphorus concentrations in the third National Health And Nutrition Examination Survey (NHANES III). Am J Kidney Dis, 2009, 53(3): 399-407.
- 56. Sullivan C, Sayre SS, Leon JB, et al. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA, 2009, 301(6): 629-635.
- 57. Bailey JL, Franch HA. Nutritional considerations in kidney disease: core curriculum 2010. Am J Kidney Dis, 2010, 55(6): 1146-1161.