Nutritional Management in Chronic Kidney Disease

Chronic kidney disease (CKD) is characterised by progressive loss of renal function and is frequently accompanied by metabolic disturbances, inflammation and altered nutrient handling. Effective nutritional management aims to slow disease progression, preserve muscle mass and reduce cardiovascular risk. Dietary strategies focus on tailored protein intake to balance catabolic needs against the risk of nitrogenous waste accumulation, controlled sodium and phosphorus consumption to mitigate hypertension and mineral bone disorder, and adequate energy provision to prevent protein‐energy wasting. Nutritional assessment incorporates clinical examination, dietary recall and laboratory indices such as serum albumin and pre‐albumin. Individualised interventions—including oral supplementation, intradialytic feeding and modulation of micronutrient status—play a central role in optimising outcomes and quality of life for patients at all stages of CKD.

Research from Nature Portfolio

Recent studies have refined prognostic tools and body‐composition markers. One investigation demonstrated that the extracellular water/total body water ratio, assessed by bioimpedance analysis in haemodialysis patients, correlates with protein‐energy wasting and independently predicts long‐term mortality, suggesting a non‐invasive indicator of fluid overload and malnutrition. Another comparative analysis evaluated the geriatric nutritional risk index against the creatinine index in a large haemodialysis cohort and found both metrics similarly predictive of all‐cause mortality, favouring the simpler geriatric index for routine nutritional surveillance and risk stratification.

Nutritional Management in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in nutritional management in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Protein‐energy wasting (PEW): A syndrome of decreased body protein and energy reserves common in CKD, marked by muscle wasting, low serum proteins and weight loss.

Extracellular water/total body water (ECW/TBW) ratio: A bioimpedance‐derived measure of fluid distribution; elevated values indicate fluid overload and are linked to malnutrition and mortality.

Geriatric Nutritional Risk Index (GNRI): A nutritional screening tool calculated from serum albumin and body weight, used to predict clinical outcomes in dialysis populations.

Prognostic Nutritional Index (PNI): A composite score based on serum albumin and lymphocyte count, reflecting nutritional and immunological status and predicting survival.

Bioimpedance analysis: A non‐invasive technique measuring body composition and fluid compartments to assess nutritional status and hydration.

References

1. Association of extracellular water/total body water ratio with protein-energy wasting and mortality in patients on hemodialysis. Scientific Reports (2023).
2. Geriatric Nutritional Risk Index (GNRI) and Creatinine Index Equally Predict the Risk of Mortality in Hemodialysis Patients: J-DOPPS. Scientific Reports (2020).
3. Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis. Nutrients (2023).
4. The Effects of Two Kinds of Dietary Interventions on Serum Metabolic Profiles in Haemodialysis Patients. Biomolecules (2023).
5. Progress in the study of nutritional status and selenium in dialysis patients. Annals of Medicine (2023).