Table 1 Nutrition management protocols of CKD Stages 4–5 (non- dialysed)

Protein

Approximately 0.75-1.0 g /kg IBW/d (Australian RDI)

Approximately 70 % HBV protein

Remark:

▪ ~0.6 g/kg IBW/d (and no less) for patients with severe symptoms (usually applicable to patients in advance stage of conservative care)

▪ For nutrition support or repletion ~ 1.0 g /kg IBW/d

▪ A high protein diet for nutrition support in malnourished patients, or weight reduction in overweight/obese patients is inappropriate

Energy

Aim to attain and maintain IBW

Depending on physical activity level

35–45 Kcal (150-190KJ)/kg IBW/d for <60 years

30–35 Kcal (130-150KJ)/kg IBW/d for >60 years

▪ energy from CHO approximately 50-60 %

▪ energy from Fat approximately 30-35 %.

Adapted to individual needs in the case of under-nutrition or overweight/obesity

Sodium

If hypertension or oedema present:

Approximately 80 mmol/d (no added salt)

▪ May need lower sodium intake if severe oedema present, e.g. 50 mmol/d

▪ May need higher sodium intake in patients with salt-losing nephropathy

Potassium

No restriction unless hyperkalaemia present

40-70 mmol/d if restriction required

Phosphorus

<1000 mg/d if hyperphosphatemia present + phosphate binders

Fat

▪ Encouraged Mono- and poly-unsaturated fats

▪ Saturated fat <10 % of energy

▪ Cholesterol <300 mg/d

Alcohol

No more than 2 standard drinks per day or advised by renal physician

Vitamins &

Minerals (diet)

Near RDI levels

Vitamins &

Minerals

(supplementation)

May need individualised calcium, iron and vitamin D supplementation. May need supplementation of Vitamin B complex, Vitamin C and folate acid near RDI levels if protein intake is <60 g/day

Fluid

UO + 500 ml/d, depending on balance

Dietary Pattern

Regular inclusion of fruit and vegetables, and dietary fibre