Modification of lifestyle and nutrition interventions for management of early chronic kidney disease

Dietary modification Protein a. We suggest that patients with progressive chronic kidney disease (CKD) have individualised diet intervention involving an appropriately qualified dietitian (2C). b. We recommend adults with early CKD consume a normal protein diet, consisting of 0.75 1.0 g/kg/day, with adequate energy. This is in line with the Recommended Daily Intake (RDI) for the general population (1C). c. A low protein diet (0.6 g/kg/day) to slow down CKD progression is not recommended due to the risk of malnutrition (1C). d. We suggest people with excess protein intakes reduce their intakes to the RDI levels as a high protein diet may accelerate renal function decline in mild renal insufficiency (2C). Salt e. We recommend that early CKD patients restrict their dietary sodium intake to 100 mmol/day (or 2.3 g sodium or 6 g salt per day) or less, as it reduces blood pressure and albuminuria in patients with CKD (1C). f. We recommend that patients with CKD should not use salt substitutes that contain high amounts of potassium salts (1D). Phosphate g. We suggest that early CKD patients (stages 1-3) should not restrict dietary phosphate intake, as restriction of dietary phosphate does not influence renal or cardiovascular outcomes in these patients (2C). Potassium h. We suggest that early CKD patients with persistent hyperkalaemia restrict their dietary potassium intake with the assistance of an appropriately qualified dietitian (2D). Polyphenol-enriched diets i. We suggest that in early CKD patients with diabetic nephropathy, consumption of a carbohydrate-restricted, low-iron-available, polyphenol-enriched (CR-LIPE) diet may slow the progression of diabetic nephropathy (2C). Caloric restriction j. We recommend that overweight/obese patients with CKD should be prescribed caloric restriction under the management of an appropriately qualified dietitian. A reduction in weight can mean improvement of CKD (1C). k. We suggest that, in the absence of specific recommendations for CKD, overweight or obese patients are encouraged to lose body fatness to aim for a Body Mass Index (BMI) closer to 18.5 – 24.9 kg/m 2 and waist circumference ≤102 cm for men and ≤88 cm for women (2C).  This is in line with the Dietary Guidelines for Australian Adults recommended by the NHMRC and Australian better health initiatives. Fruit and vegetables l. We suggest adults with early CKD consume a balanced diet rich in fruits and vegetables, as these appear to reduce blood pressure and have renoprotective effects comparable to sodium bicarbonate (2C).