The National Kidney Foundation and the Academy of Nutrition and Dietetics have updated the clinical practice guideline for nutrition in chronic kidney disease (CKD); the 2020 update was published in the American Journal of Kidney Diseases. An expert committee updated the Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Nutrition in CKD. The guideline was expanded to include patients with stages 1 to 5 CKD not receiving dialysis and those with a functional kidney transplant. The authors note that routine nutrition screening at least biannually should be considered for adults with CKD 3 to 5D or post-transplantation; a registered dietitian nutritionist (RDN) should conduct a comprehensive nutrition assessment within 90 days of starting dialysis, annually, or when indicated. Complementary tools for assessing nutritional status, including biomarkers, should be considered for adults with CKD 1 to 5D or post-transplantation. Resting energy expenditure should be determined using indirect calorimetry. Use of the 7-point Subjective Global Assessment is recommended as a valid and reliable tool for assessing nutritional status in adults with CKD 5D. Factors beyond dietary intake should be assessed to effectively plan nutritional interventions. Medical nutrition therapy should be provided by an RDN in close collaboration with a physician or other provider for adults with CKD 1 to 5D. “The updated guidelines reflect the significant improvements in the understanding and care of patients with CKD in terms of their metabolic and nutritional milieu,” a co-author said in a statement.
