Renal diet

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A renal diet is a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease or who are on dialysis. Dietary changes may include the restriction of fluid intake, protein, and electrolytes including sodium, phosphorus, and potassium. [1] Calories may also be supplemented if the individual is losing weight undesirably. [1]

Contents

The diet may help limit the buildup of waste products within the body and reduce strain on the kidneys, as well as reduce blood pressure and lower the risk of fluid build-up around the heart and lungs. [2] [3] [4] [5] Phosphorus restriction can help maintain bone health, as phosphorus buildup in the blood results in the leaching of calcium from bones and subsequently an increased fracture risk. [6] The evidence supporting uptake of a renal diet and a reduction in cardiovascular events and mortality is limited, but dietary interventions may increase health-related quality of life and estimated Glomerular Filtration Rate (eGFR) while lowering serum albumin and serum cholesterol levels. [4]

The restrictiveness of a renal diet depends on the severity of the patient's kidney disease, and the diet should be undertaken with the advice of a dietician. [5] [7] Patients with comorbid conditions like diabetes may need to further alter their diets to meet the needs of those conditions simultaneously. [7]

Who should be on a renal diet?

Diet modification is recommended in those diagnosed with CKD stage 3-5 or GFR <60 mL/min/1.732 that are NOT on dialysis. Those with eGFR greater than or equal to <60 mL/min/1.732 are recommended to follow the general population dietary recommendations (DASH diet). [8]

Sodium

Sodium restriction in CKD has been studied and recommended in individuals w/ coexisting hypertension, volume overload or proteinuria. Sodium restriction to <2 g/day (<5 g/day of salt) has shown improved blood pressure control, improved volume control and reduced proteinuria. [9] [10] [11] [12] High sodium intake of above 6g/day has been shown to increase rates of cardiovascular disease, stroke and overall mortality. [13] [14]

Avoid: High-sodium foods
  • Condiments
  • Canned vegetables/meats/fish/soups
  • Cured or smoked bacon, sausage, meats
  • Deli meats
  • Frozen dinners
  • Pickles
  • Pizza
  • Processed/packaged foods
  • Seasonings
  • Tomato sauces/marinades
Guide to reading sodium nutrition labels
Salt/sodium-freeLess than 5 mg of sodium per serving
Very low sodium35 mg or less of sodium per serving
Low sodium140 mg or less of sodium per serving
Reduced sodiumAt least 25% less sodium than the regular product
Light or lite in sodiumAt least 50% less sodium than the regular product
No salt added or unsaltedNo salt is added during processing, but these products may not be salt/sodium-free unless stated

Potassium

Potassium management for individuals with CKD is variable and dependent on various factors including CKD stage/eGFR, serum potassium levels and concomitant use of potassium altering medications such as ACE inhibitors/ARBs. Potassium regulation requires an individualized approach with the assistance of a dietician and physician.

Avoid: High-potassium food
FruitsVegetablesProteinsDairyOther
Bananas

Oranges

Raisins

Avocado

Coconut

Figs

Kiwi

Mango

Prunes

Nectarines

Cantaloupe

Artichokes

Baked beans

Beets

Brussels sprouts

Chard

Olives

Potatoes

Pickles

Pumpkin

Tomato

Acorn squash

Butternut squash

Beans (black/kidney/pinto)

Lobster

Salmon

Sardines

Scallops

Whitefish

Milk

Ice cream

Processed cheese

Yogurt

Chocolate

Peanuts

Peanut butter

Sports drinks

Low-potassium foods
FruitsVegetablesProteinsGrainFluidsSnacks
Apples

Blueberries

Cherries

Dried fruits: apples, blueberries, cherries, coconut, cranberries

Grapes

Lychee

Pear

Persimmon

Pineapple

Plum

Raspberries

Strawberries

Tangerines

Watermelon

Asparagus

Bean sprouts

Broccoli

Cabbage

Carrots

Cauliflower

Celery

Cherry tomatoes

Corn

Cucumber

Eggplant

Green or wax beans

Greens: collard, mustard, turnip

Jicama

Kale

Leeks

Lettuce

Mushrooms

Okra

Onion

Peas: green, sugar snap, snow

Peppers: green, red, yellow, jalapeño

Radish

Spinach (raw)

Squash: spaghetti, yellow

Turnips

Water chestnuts

Beans

Beef

Chicken

Edamame

Eggs (whole or egg whites)

Fish

Lamb

Lentils

Pork

Tofu

Turkey

Veal

Wild game

Bagel (half)

Bread loaf

Cereal

Corn tortilla

Couscous

English muffin (half)

Old-fashioned or steel-cut oatmeal

Pasta

Pita (half)

Quinoa

Rice

Rice cakes

Slow-cook Cream of Wheat

Slow-cook grits

100% fruit juices: apple, cranberry, grape, pineapple

Fresh-brewed coffee

Fresh-brewed tea: black, herbal

Fresh-squeezed lemonade

Nectars: apricot, guava, mango, papaya, peach, pear

Sodas: club, lemon-lime

Water: sparkling, tap

All-natural fruit leather

Animal crackers

Applesauce

Frozen fruit bars

Fruit cocktail

Homemade desserts: fruit pie or cobbler

Italian ice

Nuts, seeds and natural nut butters (2 tablespoons)

Rice Krispies Treats®

Sherbet

Unsalted snacks: crackers, pita chips, popcorn, pretzels, tortilla chips

Phosphorus and calcium

Increased serum phosphate levels in CKD is associated with poor bone health, increased risk of cardiovascular events and mortality. [15] [16] Although there isn't enough evidence that dietary restriction of phosphorus leads to decreased serum phosphorus, KDOQI recommends a maximum of 0.8 to 1 g/day intake restriction of dietary phosphorus. [17]

Serum phosphate levels in CKD are heavily influenced by calcium and parathyroid hormone levels. In CKD,  the kidneys are unable to make adequate amounts of vitamin D, resulting in decreased calcium absorption. Low calcium leads to parathyroid hormone release, which moves calcium and phosphorus out of bones and into the blood. Therefore calcium supplementation in CKD patients results in decreased PTH and decreased phosphorus levels. KDOQI recommends a calcium intake goal of 800 to 1000 mg/day (diet and medications combined). [17] Excessive calcium supplementation of 2000 mg/day for CKD patients may result in calcium deposition in other tissues leading to calcification. [18]

Avoid: High-phosphorus foods
ProteinGrainsDairyFluids
Pre-packaged or breaded meats and fish

Deli meats

Hot dogs

Processed meats

Biscuits

Muffins

Corn bread

Pancakes

Waffles

Processed cheeses

Cheese sauces

Ice cream

Milk

Pudding

Frozen yogurt

Beer

Hot cocoa

Canned soup

Some carbonated beverages, flavored waters and teas

Milk

Milkshakes

Some protein shakes

Low-phosphorus foods
ProteinGrainsDairyFruits
Fresh meats without breading or marinades

Turkey breast/thigh, skinless

Chicken breast/thigh skinless

Pork chop/roast

Salmon

Sea bass

Shrimp

Yellowfin

Flour tortillas: without baking powder

White pita bread

White bread

Sourdough bread

Almond milk

Sour cream

Soy milk

Egg whites

Cream cheese: 2 tablespoons

Parmesan cheese: 2 tablespoons

Apple

Cherries

Peach

Pineapple

Strawberries

Protein

A low protein diet for individuals with non-dialysis CKD has shown to lower the rate of CKD progression and electrolyte balance. Low protein diets of <0.8 g/kg/day have shown improved CKD management with reduced serum phosphorus, serum urea nitrogen and reduced protein in the urine. [19] [20] [21] A very low protein diet (0.28 g/kg/day) is not recommended due to the possibility of malnutrition. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a low protein diet of 0.55-0.6 g/kg/day but specific levels of protein intake varies for each individual and should be altered with the advice of a dietician and/or physician. [22] [23]

See also

Related Research Articles

<span class="mw-page-title-main">Kidney stone disease</span> Formation of mineral stones in the urinary tract

Kidney stone disease, also known as renal calculus disease, nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material develops in the urinary tract. Renal calculi typically form in the kidney and leave the body in the urine stream. A small calculus may pass without causing symptoms. If a stone grows to more than 5 millimeters, it can cause blockage of the ureter, resulting in sharp and severe pain in the lower back or abdomen. A calculus may also result in blood in the urine, vomiting, or painful urination. About half of people who have had a renal calculus are likely to have another within ten years.

<span class="mw-page-title-main">Kidney failure</span> Disease where the kidneys fail to adequately filter waste products from the blood

Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, hyperkalaemia, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anaemia.

A low-protein diet is a diet in which people decrease their intake of protein. A low-protein diet is used as a therapy for inherited metabolic disorders, such as phenylketonuria and homocystinuria, and can also be used to treat kidney or liver disease. Low protein consumption appears to reduce the risk of bone breakage, presumably through changes in calcium homeostasis. Consequently, there is no uniform definition of what constitutes low-protein, because the amount and composition of protein for an individual with phenylketonuria would differ substantially from one with homocystinuria or tyrosinemia.

<span class="mw-page-title-main">Kidney disease</span> Damage to or disease of a kidney

Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by blood tests. Nephrosis is non-inflammatory kidney disease. Nephritis and nephrosis can give rise to nephritic syndrome and nephrotic syndrome respectively. Kidney disease usually causes a loss of kidney function to some degree and can result in kidney failure, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where dialysis or a kidney transplant is the only treatment option.

<span class="mw-page-title-main">Hyperparathyroidism</span> Increase in parathyroid hormone levels in the blood

Hyperparathyroidism is an increase in parathyroid hormone (PTH) levels in the blood. This occurs from a disorder either within the parathyroid glands or as response to external stimuli. Symptoms of hyperparathyroidism are caused by inappropriately normal or elevated blood calcium excreted from the bones and flowing into the blood stream in response to increased production of parathyroid hormone. In healthy people, when blood calcium levels are high, parathyroid hormone levels should be low. With long-standing hyperparathyroidism, the most common symptom is kidney stones. Other symptoms may include bone pain, weakness, depression, confusion, and increased urination. Both primary and secondary may result in osteoporosis.

<span class="mw-page-title-main">Chronic kidney disease</span> Medical condition

Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications can relate to hormonal dysfunction of the kidneys and include high blood pressure, bone disease, and anemia. Additionally CKD patients have markedly increased cardiovascular complications with increased risks of death and hospitalization.

<span class="mw-page-title-main">Metabolic acidosis</span> Medical condition

Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. Metabolic acidosis can lead to acidemia, which is defined as arterial blood pH that is lower than 7.35. Acidemia and acidosis are not mutually exclusive – pH and hydrogen ion concentrations also depend on the coexistence of other acid-base disorders; therefore, pH levels in people with metabolic acidosis can range from low to high.

Protein toxicity is the effect of the buildup of protein metabolic waste compounds, like urea, uric acid, ammonia, and creatinine. Protein toxicity has many causes, including urea cycle disorders, genetic mutations, excessive protein intake, and insufficient kidney function, such as chronic kidney disease and acute kidney injury. Symptoms of protein toxicity include unexplained vomiting and loss of appetite. Untreated protein toxicity can lead to serious complications such as seizures, encephalopathy, further kidney damage, and even death.

Phosphate binders are medications used to reduce the absorption of dietary phosphate; they are taken along with meals and snacks. They are frequently used in people with chronic kidney failure (CKF), who are less able to excrete phosphate, resulting in an elevated serum phosphate.

Renal osteodystrophy is currently defined as an alteration of bone morphology in patients with chronic kidney disease (CKD). It is one measure of the skeletal component of the systemic disorder of chronic kidney disease-mineral and bone disorder (CKD-MBD). The term "renal osteodystrophy" was coined in 1943, 60 years after an association was identified between bone disease and kidney failure.

<span class="mw-page-title-main">Sevelamer</span> Chemical compound

Sevelamer (rINN) is a phosphate binding medication used to treat hyperphosphatemia in patients with chronic kidney disease. When taken with meals, it binds to dietary phosphate and prevents its absorption. Sevelamer was invented and developed by GelTex Pharmaceuticals. Sevelamer is marketed by Sanofi under the brand names Renagel and Renvela.

Microalbuminuria is a term to describe a moderate increase in the level of urine albumin. It occurs when the kidney leaks small amounts of albumin into the urine, in other words, when an abnormally high permeability for albumin in the glomerulus of the kidney occurs. Normally, the kidneys filter albumin, so if albumin is found in the urine, then it is a marker of kidney disease. The term microalbuminuria is now discouraged by Kidney Disease Improving Global Outcomes and has been replaced by moderately increased albuminuria.

<span class="mw-page-title-main">Secondary hyperparathyroidism</span> Medical condition

Secondary hyperparathyroidism is the medical condition of excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia, with resultant hyperplasia of these glands. This disorder is primarily seen in patients with chronic kidney failure. It is sometimes abbreviated "SHPT" in medical literature.

<span class="mw-page-title-main">Calcium-sensing receptor</span> Mammalian protein found in Homo sapiens

The calcium-sensing receptor (CaSR) is a Class C G-protein coupled receptor which senses extracellular levels of calcium ions. It is primarily expressed in the parathyroid gland, the renal tubules of the kidney and the brain. In the parathyroid gland, it controls calcium homeostasis by regulating the release of parathyroid hormone (PTH). In the kidney it has an inhibitory effect on the reabsorption of calcium, potassium, sodium, and water depending on which segment of the tubule is being activated.

Calcium acetate/magnesium carbonate is a fixed-dose combination drug that contains 110 mg calcium and 60 mg magnesium ions and is indicated as a phosphate binder for dialysis patients with hyperphosphataemia. It is registered by Fresenius Medical Care under the trade names Renepho (Belgium) and OsvaRen.

<span class="mw-page-title-main">International Society of Renal Nutrition and Metabolism</span>

The International Society of Renal Nutrition and Metabolism (ISRNM) is a learned society on nephrology that has the objective of advancing knowledge, education and awareness pertaining to nutrition and metabolism in kidney disease by fostering communication of the advancements of knowledge in renal nutrition. The ISRNM website states that it promotes expert patient care, advances medical research, and educates the kidney community on the role of nutrition in chronic kidney disease and acute kidney injury including the role of nutritional status, uremic malnutrition, protein-energy wasting, and dietary derangement. The site also mentions a role in informing policymakers about issues of relevant to kidney and nutrition communities and the patients.

Kamyar Kalantar-Zadeh is an Iranian-American physician doing research in nephrology, kidney dialysis, nutrition, and epidemiology. He is best known as a specialist in kidney disease nutrition and chronic kidney disease and for his hypothesis about the longevity of individuals with chronic disease states, also known as reverse epidemiology including obesity paradox. According to this hypothesis, obesity or hypercholesterolemia may counterintuitively be protective and associated with greater survival in certain groups of people, such as elderly individuals, dialysis patients, or those with chronic disease states and wasting syndrome (cachexia), whereas normal to low body mass index or normal values of serum cholesterol may be detrimental and associated with worse mortality. Kalantar-Zadeh is also known for his expertise in kidney dialysis therapy, including incremental dialysis, as well as renal nutrition. He is the brother of Kourosh Kalantar-zadeh, who is an Australian scientist involved in research in the fields of materials sciences, nanotechnology, and transducers.

Mesoamerican nephropathy (MeN) is an endemic, non-diabetic, non-hypertensive chronic kidney disease (CKD) characterized by reduced glomerular filtration rate (GFR) with mild or no proteinuria and no features of known primary glomerular diseases. MeN is prevalent in agricultural communities along the Pacific Ocean coastal lowlands Mesoamerica, including southern Mexico, Guatemala, El Salvador, Nicaragua, Honduras and Costa Rica. Although most cases have been described among agricultural workers, MeN has also been described in other occupations, including miners, brick manufacturers, and fishermen. A common denominator among these occupations is that they are outdoor workers who reside in rural areas in hot and humid climates.

Sucroferric oxyhydroxide, sold under the brand name Velphoro, is a non-calcium, iron-based phosphate binder used for the control of serum phosphorus levels in adults with chronic kidney disease (CKD) on haemodialysis (HD) or peritoneal dialysis (PD). It is used in form of chewable tablets.

<span class="mw-page-title-main">Andrew S. Levey</span> American nephrologist (born 1950)

Andrew S. Levey is an American nephrologist who transformed chronic kidney disease (CKD) clinical practice, research, and public health by developing equations to estimate glomerular filtration rate (GFR), and leading the global standardization of CKD definition and staging.

References

  1. 1 2 "Diet - chronic kidney disease: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2022-03-23.
  2. ↑ Hershey, Kristen (December 2018). "Renal Diet". The Nursing Clinics of North America. 53 (4): 481–489. doi:10.1016/j.cnur.2018.05.005. ISSN   1558-1357. PMID   30388974. S2CID   53272380.
  3. ↑ Akchurin, Oleh M. (February 2019). "Chronic Kidney Disease and Dietary Measures to Improve Outcomes". Pediatric Clinics of North America. 66 (1): 247–267. doi:10.1016/j.pcl.2018.09.007. ISSN   1557-8240. PMC   6623973 . PMID   30454747.
  4. 1 2 Palmer, Suetonia C.; Maggo, Jasjot K.; Campbell, Katrina L.; Craig, Jonathan C.; Johnson, David W.; Sutanto, Bernadet; Ruospo, Marinella; Tong, Allison; Strippoli, Giovanni Fm (2017-04-23). "Dietary interventions for adults with chronic kidney disease". The Cochrane Database of Systematic Reviews. 2017 (4): CD011998. doi:10.1002/14651858.CD011998.pub2. ISSN   1469-493X. PMC   6478277 . PMID   28434208.
  5. 1 2 "Eating Right for Chronic Kidney Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-03-23.
  6. ↑ "Mineral & Bone Disorder in Chronic Kidney Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-03-23.
  7. 1 2 CDC (2019-09-19). "Diabetes & Kidney Disease: What to Eat?". Centers for Disease Control and Prevention. Retrieved 2022-03-23.
  8. ↑ Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi: 10.1053/j.ajkd.2020.05.006 . ISSN   1523-6838. PMID   32829751. S2CID   221282344.
  9. ↑ Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi: 10.1053/j.ajkd.2020.05.006 . ISSN   1523-6838. PMID   32829751. S2CID   221282344.
  10. ↑ Garofalo, Carlo; Borrelli, Silvio; Provenzano, Michele; De Stefano, Toni; Vita, Carlo; Chiodini, Paolo; Minutolo, Roberto; De Nicola, Luca; Conte, Giuseppe (2018-06-06). "Dietary Salt Restriction in Chronic Kidney Disease: A Meta-Analysis of Randomized Clinical Trials". Nutrients. 10 (6): 732. doi: 10.3390/nu10060732 . ISSN   2072-6643. PMC   6024651 . PMID   29882800.
  11. ↑ Chen, Yanrong; Wang, Xiangyu; Jia, Yijie; Zou, Meina; Zhen, Zongji; Xue, Yaoming (June 2022). "Effect of a sodium restriction diet on albuminuria and blood pressure in diabetic kidney disease patients: a meta-analysis". International Urology and Nephrology. 54 (6): 1249–1260. doi:10.1007/s11255-021-03035-x. ISSN   1573-2584. PMID   34671892. S2CID   239042207.
  12. ↑ McMahon, Emma J.; Campbell, Katrina L.; Bauer, Judith D.; Mudge, David W.; Kelly, Jaimon T. (2021-06-24). "Altered dietary salt intake for people with chronic kidney disease". The Cochrane Database of Systematic Reviews. 2021 (6): CD010070. doi:10.1002/14651858.CD010070.pub3. ISSN   1469-493X. PMC   8222708 . PMID   34164803.
  13. ↑ Malta, Daniela; Petersen, Kristina S.; Johnson, Claire; Trieu, Kathy; Rae, Sarah; Jefferson, Katherine; Santos, Joseph Alvin; Wong, Michelle M. Y.; Raj, Thout Sudhir; Webster, Jacqui; Campbell, Norm R. C.; Arcand, JoAnne (December 2018). "High sodium intake increases blood pressure and risk of kidney disease. From the Science of Salt: A regularly updated systematic review of salt and health outcomes (August 2016 to March 2017)". Journal of Clinical Hypertension (Greenwich, Conn.). 20 (12): 1654–1665. doi:10.1111/jch.13408. ISSN   1751-7176. PMC   8030856 . PMID   30402970.
  14. ↑ Strazzullo, Pasquale; D'Elia, Lanfranco; Kandala, Ngianga-Bakwin; Cappuccio, Francesco P. (2009-11-24). "Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies". BMJ (Clinical Research Ed.). 339: b4567. doi:10.1136/bmj.b4567. ISSN   1756-1833. PMC   2782060 . PMID   19934192.
  15. ↑ Newsome, Britt; Ix, Joachim H.; Tighiouart, Hocine; Sarnak, Mark J.; Levey, Andrew S.; Beck, Gerald J.; Block, Geoffrey (June 2013). "Effect of protein restriction on serum and urine phosphate in the modification of diet in renal disease (MDRD) study". American Journal of Kidney Diseases. 61 (6): 1045–1046. doi:10.1053/j.ajkd.2013.01.007. ISSN   1523-6838. PMID   23415016.
  16. ↑ Palmer, Suetonia C.; Hayen, Andrew; Macaskill, Petra; Pellegrini, Fabio; Craig, Jonathan C.; Elder, Grahame J.; Strippoli, Giovanni F. M. (2011-03-16). "Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis". JAMA. 305 (11): 1119–1127. doi:10.1001/jama.2011.308. hdl: 10453/117870 . ISSN   1538-3598. PMID   21406649.
  17. 1 2 Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi: 10.1053/j.ajkd.2020.05.006 . ISSN   1523-6838. PMID   32829751. S2CID   221282344.
  18. ↑ Spiegel, David M.; Brady, Kate (June 2012). "Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets". Kidney International. 81 (11): 1116–1122. doi:10.1038/ki.2011.490. ISSN   1523-1755. PMC   3352985 . PMID   22297674.
  19. ↑ Rhee, Connie M.; Ahmadi, Seyed-Foad; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar (April 2018). "Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials". Journal of Cachexia, Sarcopenia and Muscle. 9 (2): 235–245. doi:10.1002/jcsm.12264. ISSN   2190-6009. PMC   5879959 . PMID   29094800.
  20. ↑ Yan, Bingjuan; Su, Xiaole; Xu, Boyang; Qiao, Xi; Wang, Lihua (2018). "Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis". PLOS ONE. 13 (11): e0206134. Bibcode:2018PLoSO..1306134Y. doi: 10.1371/journal.pone.0206134 . ISSN   1932-6203. PMC   6221301 . PMID   30403710.
  21. ↑ Hahn, Deirdre; Hodson, Elisabeth M.; Fouque, Denis (2020-10-29). "Low protein diets for non-diabetic adults with chronic kidney disease". The Cochrane Database of Systematic Reviews. 10 (10): CD001892. doi:10.1002/14651858.CD001892.pub5. ISSN   1469-493X. PMC   8095031 . PMID   33118160.
  22. ↑ Menon, Vandana; Kopple, Joel D.; Wang, Xuelei; Beck, Gerald J.; Collins, Allan J.; Kusek, John W.; Greene, Tom; Levey, Andrew S.; Sarnak, Mark J. (February 2009). "Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study". American Journal of Kidney Diseases. 53 (2): 208–217. doi:10.1053/j.ajkd.2008.08.009. ISSN   1523-6838. PMID   18950911.
  23. ↑ Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi: 10.1053/j.ajkd.2020.05.006 . ISSN   1523-6838. PMID   32829751. S2CID   221282344.
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