The document provides nutritional recommendations for adults with chronic kidney disease stages 3 to 4. It recommends a daily protein intake of ≤0.8 g/kg, sodium intake <2.3 g/day, potassium intake individualized to serum levels, calcium intake ≤1.5 g/day, phosphorus intake of 0.8-1 g/day, and carbohydrate/fat intake of 30-35 kcal/kg/day with <30% from fat. It also recommends 25-38 g of fiber per day.

1. Never let the future disturb you. You will meet it, if you have to, with the same weapons of
reason which today arm you against the present
-Marcus Aurelius
OVERVIEW
● depending upon
○ GFR
○ Proteinuric or nonproteinuric
○ other comorbidities
○
●​A daily protein intake of 0.8 g/kg
●​A diet rich in vegetables.
●​The sodium intake <2 g/day
●​The potassium intake should be guided by serum potassium levels.
If the potassium concentration is high, dietary potassium intake should be restricted
●​Some clinicians target a total calcium intake (both dietary and medication sources) ≤1500
mg/day, whereas others prefer a more stringent goal of ≤1000 mg/day.
●​Maximum phosphorus intake of 0.8 to 1 g/day, even if the serum phosphorus
concentration is normal
●​Maximum caloric intake of 30 to 35 kcal/kg/day.
●​Maximum fat intake <30 percent of daily energy intake, with saturated fat limited to <10
percent energy.
●​Daily dietary fiber intake for 25 to 38 g/day.
PROTEIN INTAKE
● Non-nephrotic patients
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by Dr. Eashan Srivastava

2. Never let the future disturb you. You will meet it, if you have to, with the same weapons of
reason which today arm you against the present
-Marcus Aurelius
○ daily protein intake to 0.8 g/kg
○ KDIGO suggest restriction in protein intake for CKD patients
○ a/w favorable laboratory and metabolic effects
○ <0.6 g/kg/day = Not recommended
● Patients with nephrotic syndrome
○ do not restrict protein intake
● Source of protein intake
○ protein from plant sources may be beneficial
SALT INTAKE
● 1 g salt of NaCl contains 0.4 g (17 mEq) of Na
● <2 g/day (5 g/day of salt)
○ eGFR) <60 mL
○ Hypertension
○ volume overload
○ increased protein excretion
● very-low-sodium intake has been associated with increased mortality
POTASSIUM INTAKE
● potassium restriction is not required until GFR <30 mL
● [K] depends on
○ variability between patients
○ Intake
○ Drugs (ACEI/ARB)
● KDOQI guideline recommends potassium intake
○ 2 to 4 g/day (51 to 102 mEq/day) for patients with CKD stages 3 to 4
○ no restriction for those in CKD 1,2
○ individually tailored based on the level of eGFR and serum potassium levels.
CALCIUM INTAKE
● total calcium intake (both dietary and medication sources) ≤1500 mg/day
● Calcium 2 to 4 g/day results in
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by Dr. Eashan Srivastava

3. Never let the future disturb you. You will meet it, if you have to, with the same weapons of
reason which today arm you against the present
-Marcus Aurelius
○ suppression of PTH
○ CKD-MBD
○ vascular calcification
PHOSPHORUS INTAKE
● restrict dietary phosphorus intake to a maximum of 0.8 to 1 g/day in eGFR <60
● Because inorganic phosphate has much higher bioavailability compared with organic
phosphate, sources rich in inorganic phosphate such as highly processed foods should
be avoided
● Organic phosphate (ie, from unprocessed foods) must be hydrolyzed enzymatically in
the gut before it can be absorbed
● Dietary phosphate load is closely related to protein content
CARBOHYDRATE AND FAT INTAKE
● eGFR <60 mL/min/1.73 m​2​ who are NOT undergoing maintenance dialysis consume 30
to 35 kcal/kg/day
● Fat should be restricted to <30 percent of daily energy
● saturated fat limited to <10 percent energy.
RECOMMENDED FIBER INTAKE
● 5 to 38 g/day, which is the same as for the general population
● Dietary fiber is the nondigestible form of carbohydrates and lignin
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by Dr. Eashan Srivastava

4. Never let the future disturb you. You will meet it, if you have to, with the same weapons of
reason which today arm you against the present
-Marcus Aurelius
● recommended a daily intake of 14 g per 1000 calories
Nutritional recommendations for adults with chronic kidney disease
stages 3 to 4
Protein ≤0.8 g/kg/day​[1]​, increase plant source.
Salt <2.3 g/day (<5 g/day of NaCl)​[1]​.
Potassium Individualize to keep the serum potassium within a normal range.
Calcium 1.5 g/day from both dietary and medication sources.*
Phosphorus 0.8 to 1 g/day or individualize to keep the value within a normal range.
Increase vegetable source and avoid processed foods as much as possible.
Carbohydra
te/fat​​[2]
30 to 35 kcal/kg/day; <30% of total calories from fat and <10% of total fat from
saturated fat; DASH diet pattern highly recommended.
Fiber​​[3] 25 to 38 g/day
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by Dr. Eashan Srivastava