|KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease, 2007 GUIDELINE 5: NUTRITIONAL MANAGEMENT IN DIABETES AND CHRONIC KIDNEY DISEASE|
Management of diabetes and CKD should include nutritional intervention. Dietary modifications may reduce progression of CKD.|
5.1 Target dietary protein intake for people with diabetes and CKD stages 1–4 should be the RDA of 0.8 g/kg body weight per day. (B)
Nutritional management for people with diabetes has traditionally focused on blood glucose control. However, dietary protein intake at all stages of CKD appears to have an important impact in this population. If dietary protein is limited, adequate caloric intake must be maintained by increasing calories from carbohydrates and/or fats. Competing needs for nutritional management of hyperglycemia, hypertension, and dyslipidemia can make determination of appropriate protein intake challenging. Furthermore, the diet for diabetes and CKD should consider the qualitative, as well as the quantitative, aspects of proteins, carbohydrates, and fats. To address dietary recommendations for people with diabetes and CKD stages 1 to 4, studies evaluating interventions that reduced or altered sources of dietary protein and other nutrients were reviewed. Dietary recommendations for CKD stage 5 are provided in the KDOQI™ CPGs for Nutrition in Chronic Renal Failure.
A dietary protein intake of 0.8 g/kg body weight per day, the RDA for this macronutrient, is a level that has been achieved in studies of diabetes and CKD. Reduction in albuminuria and stabilization of kidney function have been reported with dietary protein intake at the RDA level. Nutrition surveys indicate that most people eat in excess of the RDA for dietary protein. (Moderate)