Professor Xing Changying: New concepts in nutritional therapy for patients with chronic kidney disease

Patients with chronic kidney disease (CKD) are prone to nutritional disorders. First of all, we must distinguish between overnutrition (obesity), malnutrition (cachexia) and protein-energy wasting. To properly treat CKD patients, we must first monitor the patient's 24-hour protein, potassium, sodium, chloride, magnesium, phosphorus and water intake, then formulate a nutritional prescription, and evaluate protein-energy wasting in dialysis patients. The main purpose of dietary treatment is to delay the decline in glomerular filtration rate and improve the patient's survival rate and quality of life. The main measures are as follows.

1. Implement a "heart-healthy diet". According to the "2021 AHA Cardiovascular Healthy Diet Guidelines", dietary treatment is required. A heart-healthy diet can slow the progression of kidney disease. Recommended diets include the Mediterranean diet, the DASH diet, and a vegetarian diet.

2. Moderately limit protein intake. Protein intake should be controlled at 0.6-0.8 g/(kg·bw), and should not be lower than 0.6 g/(kg·bw). The biggest change is the change in protein type, changing animal protein to plant protein, especially tofu in my country.

3. Scientifically control the amount of water intake. Patients are required to achieve a urine output of 2000-3000 ml/d. If there is no heart failure, severe edema or volume overload that requires limiting fluid intake, most non-dialysis CKD patients can drink more water to reduce the burden on the kidneys, reduce tubular energy consumption and tubular lumen obstruction, etc. They can drink green tea and moderate amounts of coffee.

4. Limit salt intake. The daily salt intake is 2 to 5 g. Most patients find it difficult to reach this goal. Testing 24-hour urine sodium chloride can more accurately assess the patient's salt intake.

5. Engage in appropriate physical exercise; quit smoking and limit alcohol consumption.

6. Supplement the substances that are lacking in the body, such as vitamin D, magnesium and vitamin K2.

7. Supplement substances that are beneficial to the body, such as short-chain fatty acids, curcumin, probiotics, etc.

Professor Xing Changying, First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital)

Chairman of the Jiangsu Nephrology Branch of the Chinese Medical Association

Chairman of Jiangsu Medical Doctors Association

Chairman of the Jiangsu Provincial Committee of Integrated Traditional Chinese and Western Medicine Nephrology

Chairman of Jiangsu Nephrology Medical Quality Control Center

Standing Committee Member of Nephrology Branch of Chinese Medical Doctor Association

Vice Chairman of Blood Purification Branch of Jiangsu Hospital Association

Source: 2023 Blood Purification Forum of the Chinese Medical Association Nephrology Branch - Daily News