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. 2022 Nov;41(6):657-669.
doi: 10.23876/j.krcp.21.203. Epub 2022 Jan 21.

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction

Kunitoshi Iseki  1   2   3
Affiliations

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction

Kunitoshi Iseki. Kidney Res Clin Pract. 2022 Nov.

Abstract

The clinical practice guidelines (CPGs) for nutrition in chronic kidney disease (CKD) were updated after 20 years from the previous guidelines by the Kidney Disease Outcomes Quality Initiative (KDOQI). During this period, the severity of CKD was defined by eGFR and albuminuria by the organization Kidney Disease: Improving Global Outcomes (KDIGO). Main risk factors for CKD such as hypertension, hyperlipidemia, obesity, metabolic syndrome, and diabetes mellitus are closely related to lifestyle. Nutritional management is important to prevent and retard the progression of CKD. Members of the International Society of Renal Nutrition and Metabolism (ISRNM) reviewed the KDOQI CPG draft. ISRNM is an international scientific society comprising members of multiple subspecialties. ISRNM proposed the medical term protein-energy wasting (PEW), which is a keyword in renal nutrition. The prevalence of PEW among dialysis patients is high. The success of dietary therapy depends on adherence to the diet. It has to be palatable, otherwise eating habits will not change. To prevent the development and progression of CKD and PEW, regular consultation with an expert dietitian is required, especially regarding salt and protein restriction. Our cluster-randomized trial showed that intervention by a dietician was effective at retarding the progression of stage 3 CKD. In this review, I focus on salt (sodium) restriction and introduce tips for salt restriction and Japanese kidney-friendly recipes. Due to the lack of randomized controlled trials, nutritional management of CKD inevitably relies on expert opinion. In this regard, well-designed observational studies are needed. Too strict salt restriction may decrease quality of life and result in PEW.

Keywords: Chronic kidney disease; Dialysis; Hypertension; Salts; Sodium.

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Conflict of interest statement

Conflicts of interest

The author has no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Tips for salt restriction when buying cooked foods and eating out.
Modified from Iseki and Yamagata [13] according to the Creative Commons License.
Figure 2.
Figure 2.. List of high salt foods.
Modified from Iseki and Yamagata [13] according to the Creative Commons License.
Figure 3.
Figure 3.. Tips to estimate salt content.
Modified from Iseki and Yamagata [13] according to the Creative Commons License.
Figure 4.
Figure 4.. List of seasoning materials to reduce salt intake.
Modified from Iseki and Yamagata [13] according to the Creative Commons License.
Figure 5.
Figure 5.. Trends in salt intake in Japan.
Data are from the National Survey of the Ministry of Health, Labor and Welfare.
Figure 6.
Figure 6.. Trends in prevalence, per million population, of chronic dialysis patients in Japan.
Data are from the Japanese Society for Dialysis Therapy. Modified and prepared by Iseki K.
See this image and copyright information in PMC

References

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